Small-bowel capsule endoscopy in patients with gastrointestinal food allergy.

BACKGROUND: Food allergy may present with a plethora of gastrointestinal and extraintestinal symptoms such as abdominal pain, diarrhea, cardiocirculatory symptoms, cutaneous reactions, or rhinitis. Macropathological lesions like lymphofollicular hyperplasia and erosive or ulcerative lesions have seldom been described in gastroscopy and colonoscopy previously. METHODS: Fifteen patients presenting with unspecific abdominal symptoms in which food allergy was detected in due course were included. During the examination process, those patients showed various indications for small-bowel capsule endoscopy, such as weight loss and anemia. RESULTS: Fourteen (93.3%) of the 15 small-bowel capsule endoscopies could be assessed, showing nonerosive lesions such as erythema, swelling, and lymphoid hyperplasia in 8 patients (57.1%) and erosive lesions such as aphthoid lesions, erosions, and petechiae in 4 patients (28.6%) with food allergy. CONCLUSION: In 15 patients with confirmed food allergy and after exclusion of other diseases, 12 (85.7%) showed various unspecific nonerosive or erosive mucosal lesions within the small bowel, resulting, however, partially in grave consequences such as anemia. Lymphoid hyperplasia was the most prominent finding in 7 patients (50%), albeit infectious disease had been excluded. Anemia improved within 1 year after adequate antiallergic treatment.

Effect of racing on cardiac troponin I concentration and associations with cardiac rhythm disturbances in Standardbred racehorses.

INTRODUCTION/OBJECTIVES: Accumulating evidence indicates intense exercise can be associated with myocardial damage. Investigating the impact of maximal effort on myocardium and exploring possible association of injury with rhythm disturbance requires a high-sensitivity cardiac troponin assay. The objectives of this study were: (1) to determine the effect of racing on serum cardiac troponin I (cTnI) in Standardbred horses using a high-sensitivity assay; (2) to determine the 99th percentile of cTnI in healthy horses and investigate the effect of demographic variables on cTnI prevailing pre-race in Standardbred horses using a validated high-sensitivity assay and a contemporary assay, and; (3) to explore associations between exercise-associated arrhythmia and cTnI concentration. ANIMALS: Racehorses (n = 145). MATERIALS AND METHODS: ≤ 2 h pre-race, cTnI concentrations were measured in 158 race starts. Electrocardiogram (ECG) monitoring was applied during racing and race recovery and screened for complex ventricular arrhythmia. Associations between cTnI prevailing before racing concentration, age, sex, and gait were investigated. Demographic and performance variables were evaluated for associations with cTnI concentration post-race and rhythm disturbance. RESULTS: Incidence of arrhythmia was 11.6% (16 horses). A significant increase in median (interquartile range) cTnI concentration of 1.36 (0.49-2.81) ng/L was found post-race (p < 0.0001). Serum cardiac troponin I (cTnI) concentration prevailing pre-race was positively associated with increasing age, and gait. Serum cardiac troponin I prevailing post-race was positively associated with concentration prevailing pre-race. Interaction between arrhythmia and finishing distanced revealed horses finishing distanced and experiencing arrhythmia displayed higher cTnI release than with the presence of either alone. CONCLUSIONS: Racing increased cTnI concentration. Horses finishing distanced and also exhibiting arrhythmia may be experiencing myocardial compromise.

Risk factors for duration of equine rhinitis A virus respiratory disease.

BACKGROUND: Infectious respiratory disease is common in young horses and can impact athletic performance and long-term health. Significant variation in the duration of clinical disease has been observed, even in the absence of secondary complications. The determination of factors associated with disease chronicity may facilitate clinical decision-making and the development of improved biosecurity protocols. OBJECTIVE: To investigate contact network characteristics, and demographic variables associated with time to clinical recovery from Equine Rhinitis A virus respiratory disease. STUDY DESIGN: Prospective cohort study. METHODS: Yearling Standardbred racehorses (n = 58) housed in a multi-barn training facility in Southern Ontario were included. Horses were monitored daily for clinical signs of acute respiratory disease over a 41-day period in Autumn 2017. Contact patterns between horses, including older racehorses, were determined through use of proximity loggers attached to halters during the initial 7-day of the study. Associations between duration of disease, demographic factors (birth month, gait, sex and yearling sale), serologic titres and network metrics (degree, betweenness and Eigenvector centrality) were investigated using a Cox proportional hazard model. RESULTS: Yearling attack rate for infectious respiratory disease was 87.9% (n = 51). Median time to recovery was 6 days (IQR = 1-32) and 17 horses were censored due to early withdrawal or failure to recover during the study period. In those yearlings born February-May, birth month was significant in the Cox proportional hazard model (Hazard Ratio 0.7, 95% CI 0.49-1, P = 0.05). MAIN LIMITATION: Probability of censoring was not independent of outcome which necessitated use of sensitivity analysis. CONCLUSIONS: These findings suggest late born foals are less likely to recover quickly from infectious respiratory disease.

Post-exercise cardiac troponin I release and clearance in normal Standardbred racehorses.

BACKGROUND: There are currently no studies detailing cardiac troponin I (cTnI) release in normal horses post-exercise using an analytically validated assay. These data are essential for selecting appropriate sampling times in equine athletes with suspected myocardial injury. OBJECTIVE: To plot the magnitude and time course of cTnI release after maximal effort, using validated cTnI assays. STUDY DESIGN: Descriptive longitudinal study. METHODS: Five clinically normal Standardbred racehorses in race training were included in the study. Horses were exercised in harness at near-race intensity. Blood samples were taken immediately pre- and post-exercise and then hourly for 24 h. Samples were analysed using the validated high-sensitivity cTnI assay and a contemporary sensitivity cTnI assay. RESULTS: Mean resting cTnI was 1.33 ± 0.6 s.d. ng/L (range, 0.82-2.33 ng/L) using assay A. All horses were below the detection limit at rest using assay B. Peak elevation occurred 2-6 h post-exercise with both assays (mean, 4.6 ± 1.7 and 4.0 ± 2 h, respectively). Mean peak increase in cTnI was 11.96 ± 9.41 ng/L (range, 1.72-23.76 ng/L) using assay A. Peak concentrations were detectable in three of the horses using assay B and were between 0.039 and 0.051 µg/L (mean: 0.043 ± 0.006 µg/L). All horses returned to baseline within 24 h. MAIN LIMITATIONS: A small (n = 5) convenience sample was used as random sampling was not logistically possible. CONCLUSIONS: All horses experienced an increase in cTnI post-exercise, with peak occurring 2-6 h post-exercise. Cardiac troponin I elevation was detected earlier using the high-sensitivity assay, which may convey a diagnostic advantage. Targeted studies are needed to determine the significance of these increases.

Extent and duration of small intestinal mucosal injury in intractable diarrhea of infancy.

Thirty infants with intractable diarrhea of infancy (IDI) underwent small bowel biopsies in order to determine the extent and duration of small intestinal mucosal injury. The onset of the persistent diarrhea occurred prior to 3 months of age and continued for an average of 48 days prior to investigation. In 18 cases, no associated entities were found. Mucosal injury was invariably found in all 30 infants: grade IV injury in 11, grade III in eight, grade II in nine, and grade I atrophy in one. Disaccharidase activities were diminished and corresponded to the degree of atrophy. Lactase activity was diminished to a greater extent than sucrase and maltase. Significant, persistent mucosal injury existed for an average of six months in 16 of the 23 (70%) repeat biopsies. All infants were given an elemental diet (ED). Twelve of the 30 infants required parenteral nutrition (PN). These infants were gradually advanced to an oral elemental diet and maintained on this diet until histologic findings and disaccharidase levels were normal. Eighteen infants were fed and maintained on an elemental diet by mouth from time of admission until normal histologic findings and disaccharidases were found. No mortality occurred during management and follow-up. Twenty-two of the 28 infants in whom follow-up growth data were available excelled in weight and height velocity. The data suggest that prolonged injury to the small intestinal mucosa is a common finding in many cases of intractable diarrhea of infancy. Elemental diets should be started early in the course of protracted diarrhea in young infants, and may need to be continued for several months since histologic and enzymatic changes of the small intestine may persist for extended periods.

Recurrent abdominal pain and lactose absorption in children.

The association of lactase deficiency with recurrent abdominal pain was investigated. One hundred three white children between the ages of 6 to 14 years with recurrent abdominal pain were evaluated. Sixty-nine underwent lactose tolerance tests and 26 had intestinal biopsies with lactase determinations; 21 of 69 (30.4%) had abnormal lactose tolerance tests and eight of 26 (31%) were lactase deficient. However, 16 of 61 (26.4%) control subjects matched for age and ethnic background exhibited lactase deficiency. Thus, a similar prevalence of lactase deficiency was found in the control and the recurrent abdominal pain groups. Thirty-eight patients with recurrent abdominal pain completed three successive six-week diet trials conducted in a double-blind fashion. An increase above base line value in pain frequency was seen in ten of 21 (48%) lactose malabsorbers and four of 17 (24%) lactose absorbers. After a 12-month milk elimination diet, six of 15 (40%) malabsorbers and five of 13 (38%) absorbers had elimination of their pain. This result compared with improvement occurring in five of 12 (42%) absorbers with recurrent abdominal pain who received a regular diet for one year and suggests that the elimination of lactose will not affect the overall frequency of improvement in recurrent abdominal pain. In addition, the recovery rate from recurrent abdominal pain is similar in both lactose absorbers and nonabsorbers independent of dietary restrictions.

Computed axial tomographic scanning of the thigh: an alternative method of nutritional assessment in pediatrics.

In this study we compared the findings of computed axial tomographic (CT) scanning of the thigh with the findings of arm anthropometry and urinary creatinine determinations to assess nutrition in children with inflammatory bowel disease receiving total parenteral nutrition. All 14 children received our standard solution for total parenteral nutrition as well as prednisone and sulfasalazine (Azulfidine) therapy. All patients were assessed by arm anthropometry, 24-hour urine collections for creatinine clearance, and CT scanning of the thigh during total parenteral nutrition. Arm muscle and fat area were estimated by anthropometry, and those in the thigh were estimated by CT scanning. Our results show the total muscle area from the CT scan can predict muscle mass calculated from the urinary creatinine excretion rates. In addition, there is a close correlation between the thigh muscle area as measured by CT scanning and the muscle area calculated from urinary creatinine excretion rates. In addition, the comparison of thigh muscle area and thigh fat area to the midarm muscle area and midarm fat area, respectively, showed that the thigh is a better predictor of muscle than fat in the midarm. We conclude that the total thigh muscle area is a better predictor of muscle mass as compared to the midarm muscle area. In addition, the CT scan cut at the level of the thigh in children and adolescents with inflammatory bowel disease can provide valuable information about the thigh compartment and analyses of different cross-sectional areas of the thigh.

High-fat semielemental diet in the treatment of protracted diarrhea of infancy.

The capacity for greater fat absorption relative to carbohydrate absorption in protracted diarrhea of infancy was studied in a developed and a developing country (Buffalo, NY, and Bangkok, Thailand). Fifty patients with protracted diarrhea in the first year of life (defined as liquid stools of more than 20 mL/kg per day with more than a 14-day duration) were randomly assigned to receive either a standard semielemental diet (Pregestimil) or a high-fat semielemental diet that contained 40% more fat. The increased fat was largely in the form of medium-chain triglycerides, with the new diet providing 60% of the fat as medium-chain triglycerides compared with 40% in the standard diet. Tolerance to both diets was good in both studies. Both groups showed adequate weight gain and an improvement in anthropometric and biochemical parameters. The patients receiving the high-fat diet showed no initial weight loss, however, and their weight gain was initiated earlier. Cumulative weight gain was also higher in the group receiving the high-fat semielemental diet. Fecal fat analyses were performed after 1 week of therapy. There was no difference observed in the coefficient of fat absorption between the groups receiving the two formulas, indicating that infants with protracted diarrhea may be able to tolerate a higher fat intake than is normally provided. As carbohydrate intolerance is known to be a complicating factor when using semielemental enteral feeds for infants with protracted diarrhea, a higher-fat semielemental diet may be the most appropriate way to provide adequate caloric intake.

Nutrition and exocrine pancreatic function in infancy: effects of total parenteral nutrition and first degree malnutrition.

Thirty-six infants suffering from gastrointestinal diseases during infancy were evaluated for exocrine pancreatic function by means of the pancreozymin-secretin test. Duodenal fluid volume, protein content, and content and peak-specific activity of amylase, lipase, and trypsin were determined following intravenous administration of either pancreozymin (CCK) or secretin. Seven infants receiving long-term parenteral nutrition and 17 infants receiving oral feedings and exhibiting first-degree malnutrition in association with chronic diarrhea underwent testing. Results were compared to those of a group of 12 age-matched infants with chronic diarrhea and weight loss. Four patients receiving total parenteral nutrition (TPN) suffered from severe short bowel syndrome and three had intractable diarrhea of infancy. The total duration of TPN ranged from 1.5-12 months, and the period of exclusive TPN in the absence of oral feedings ranged from 1-4 months. The heights, weights, and weight-for-height relationships were at or above the fifth percentile for all seven infants. The weight-for-height relationship of each patient in the control group was above the fifth percentile, while that of all malnourished infants was below the fifth percentile. No significant difference was found in the volume of fluid collected following either CCK or secretin administration. The content and concentration of amylase and lipase were lower in those patients receiving TPN. The levels were statistically significant (p less than 0.05) following secretin administration. In contrast, the peak-specific activity and total trypsin content, as well as protein content, was not significantly different in patients receiving TPN, controls, and malnourished patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Selectivity of quercetin inhibition on stimulated amylase release in rat pancreatic acini.

Quercetin (Q) has been shown to inhibit Ca2+-dependent processes. The present study evaluates the effect of Q on amylase release stimulated by various agonists in dispersed rat pancreatic acini. Q inhibited amylase release stimulated by an optimal concentration of carbachol. The inhibition was dependent on Q concentration. Preincubation with Q was not necessary. Maximal inhibition (up to 60% of control) was reached at 50 microM of Q and was completely reversible. Full responsiveness of the acini to agonist stimulation was reestablished as early as 5 min upon the removal of Q. At 50 microM, Q inhibited stimulated amylase release by optimal concentrations of tetradecanoylphorbol-13-acetate (TPA) (10(-6) M), A23187 (3 x 10(-6) M), cholecystokinin C-terminal octapeptide (CCK-OP) (10(-9) M) and carbachol (3 x 10(-6) M), but not by vasoactive intestinal polypeptide (VIP) (3 x 10(-7) M). Instead, Q promoted amylase release stimulated by VIP. The inhibition of amylase secretion by Q occurred only at near optimal, optimal, and supraoptimal concentrations of TPA, A23187, CCK-OP, and carbachol. The potentiation effect of Q on VIP-stimulated amylase secretion was, however, seen at all concentrations of VIP used (10(-8) to 10(-6) M). Quercetin also inhibited protein kinase C activity from rat pancreas in a dose-dependent manner. Maximal inhibition (approximately 85%) was seen at 100 microM of Q. These results provide further support that the intermediary steps for stimulated enzyme secretion in pancreatic acini by TPA, A23187, CCK-OP, and carbachol involve calmodulin and/or protein kinase C, whereas VIP does not.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastrointestinal bleeding in children: an overview of conditions requiring nonoperative management.

Gastrointestinal bleeding in infants and children is a common problem in the practice of general pediatrics. This report outlines the diagnosis and management of gastrointestinal bleeding in children that does not require surgical or invasive intervention. The spectrum of responsible entities are quite diverse and include a variety of immune-mediated diseases, peptic diseases, drug induced disorders, infections, and coagulation disorders. Through understanding the nature of the above-described problems, appropriate diagnostic and management principles can be applied.

Catheter-related complications in 35 children and adolescents with gastrointestinal disease on home parenteral nutrition.

A 7-year experience with home parenteral nutrition (HPN) in 35 children and adolescents suffering from severe gastrointestinal diseases is reported. The average duration of HPN was 577 days with a mean of 2.9 catheters per patients. There was a total of 82 episodes of proven catheter-related sepsis, an average of 1.5 septic episodes per patient year. In about half of these instances, the catheter had to be removed. Coagulase-negative and -positive staphylococci were the most common organisms isolated. All four Candida infections led to removal of the catheter. Children requiring HPN from early infancy had a higher frequency of catheter-related infections than those started on HPN after the first year of life. In four cases, clinically significant thrombotic complications occurred. The results suggest that even under optimal conditions of catheter placement and with extensive education in aseptic catheter handling, infection is still relatively common in children receiving HPN. However, there was no mortality related to this complication.

Effects of parenteral nutrition on whole body and extremity composition in children and adolescents with active inflammatory bowel disease.

The effect of parenteral nutrition (PN), combined with corticosteroid therapy, on body composition was evaluated in 22 pediatric patients with active and complicated inflammatory bowel disease (IBD). The patients were divided into two groups according to the duration of PN. Group A consisted of 14 patients who received PN for an average of 43 days (short term) whereas eight patients received PN for an average of 104 days (long term); group B. Nutritional assessments were performed before and following the PN periods. In addition, a follow-up assessment was performed 50 days after the cessation of PN for group A. Serial evaluations included; weight, height, disease activity score, arm anthropometry, subscapular skinfold (SSSF) thickness, 24-hr urinary creatinine, and computed tomography (CT) scan of the thigh. Following PN with a glucose-fat mixture used as a nonprotein energy source, there were significant (p less than 0.05) increases in weight, SSSF, and muscle mass (MM) in both groups. Disease activity declined in both groups and height increased in group B and at the follow-up assessment for group A. Considering extremity composition, both groups exhibited increases in midarm muscle area, midarm fat area, thigh muscle area, and thigh fat area. However, a differential distribution of incremental change was observed depending on the duration of PN. Fat deposition predominated in both the upper and lower extremities for group A. Group B patients, however, although showing a predominance of fat accumulation in the upper extremities, gained muscle and fat components equally in the lower extremities.(ABSTRACT TRUNCATED AT 250 WORDS)

Laser-based detectors in chromatographic analysis.

Advances in detection technology have been a vital part of the development of microscale chromatographic techniques. Separation techniques such as microbore liquid chromatography impose severe constraints on the permissible volume of detector cells. The use of lasers to construct a new generation of chromatographic detectors has satisfied the need for low volume detection and high sensitivity. The unique properties of laser radiation have been used to advantage in designing new approaches to the detection of optical absorbance through fluorescence emission and thermal effects. New approaches to monitoring refractive index changes and optical rotation have also been developed. Together, the combination of microscale-separation techniques and highly sensitive detection provide a powerful tool for analysing small quantities of samples. Yet, there are practical limitations arising from the cost and complexity of much of the instrumentation reported to date, as well as the difficulties of preparing small samples for analysis which have limited the wide-scale application of these methods to solve practical problems. Recent advances in laser technology such as the advent of diode lasers may be useful in overcoming some of these limitations.

Reversed-phase liquid chromatography of the opioid peptides. 3. Development of a microanalytical system for opioid peptides involving microbore liquid chromatography, post-column derivatization and laser-induced fluorescence detection.

A microanalytical system has been developed for the determination of peptides in small samples. Naphthalene-2,3-dicarboxaldehyde-beta-mercaptoethanol (NDA-BME) was used as the labelling reagent system as an alternative to NDA-cyanide (NDA-CN) because of the faster labelling when CN was replaced by a thiol. The fluorescence characteristics of the NDA-thiol adducts, N-substituted 1-alkylthiobenz[f]isoindoles (TBIs), were found to be different from the previously described cyanobenz[f]isoindole (CBIs) adducts formed by the reaction of primary amines with NDA-CN. The excitation maximum of the TBI adducts was at 460 nm, which was closer to the 457.9 nm argon-ion laser line, than the 440-nm maximum of the CBI adduct. The limit of detection for leucine enkephalin was 36 fmol (S/N = 3) and linearity was proven for greater than 2 orders of magnitude, from 45 fmol to 9 pmol for an injection volume of 60 nl. The detectability was limited by the high background noise produced by the post-column derivatization system. The utility of the system was demonstrated for the analysis of methionine enkephalin and its potential oxidation products, using leucine enkephalin as a suitable internal standard.

Intractable diarrhea of infancy. An alternative treatment strategy.

Prolonged diarrhea in an adult is a serious problem; in an infant it is life threatening. Conventional therapy for intractable diarrhea of infancy, which involves use of clear liquids and gradual reintroduction of cow's milk or formula, works in most situations. However, for some infants this type of management exacerbates diarrhea. As alternative therapy, the authors recommend use of oral elemental diets in most infants and total parenteral nutrition in some. This would lessen the likelihood of diarrhea exacerbation and decrease morbidity and mortality.

Troponin assays in the assessment of the equine myocardium.

In 2000, troponin assays were adopted as the test of choice for detection of myocardial injury in man. This decision was made after extensive testing and followed a 60 year search for a biomarker of myocardial damage with sufficient analytical sensitivity and specificity. This has led to proliferation of assays for use in human medicine, each requiring extensive testing and validation before it could be made available on the open market for human use. The search for ever-more analytically sensitive assays and for a standard reference material continues. The adoption of troponin testing in veterinary medicine followed shortly after its development for use in man, providing a much-needed means of detecting and monitoring myocardial damage in horses. However, application of these tests in veterinary medicine has exclusively involved use of assays designed for and clinically validated in human patients. There is no mandated requirement for test validation in veterinary medicine and, while many of these assays have been shown to be capable of detecting equine troponin, the wide diversity of available tests, lack of validation, absence of protocols for their use and lack of standardisation make their application problematic. The objective of this review article is to address this issue, offering guidance where data are available and encouraging caution where there are none. Ultimately, the overall goal of this review is to examine critically the use of troponin assays in the horse and to promote the accurate and appropriate interpretation of valid results.

Analysis of immediate ex vivo release of nitric oxide from human colonic mucosa in gastrointestinally mediated allergy, inflammatory bowel disease and controls.

Nitric oxide (NO) is a local mediator in inflammation and allergy. The aim of this study was to investigate whether live incubated colorectal mucosal tissue shows a direct NO response ex vivo to nonspecific and specific immunological stimuli and whether there are disease-specific differences between allergic and chronic inflammatory bowel disease (IBD). We took biopsies (n=188) from 17 patients with confirmed gastrointestinally mediated food allergy, six patients with inflammatory bowel disease, and six control patients. To detect NO we employed an NO probe (WPI GmbH, Berlin, Germany) that upon stimulation with nonspecific toxins (ethanol, acetic acid, lipopolysaccharides), histamine (10(-8)-10(-4)M), and immune-specific stimuli (anti-IgE, anti-IgG, known food allergens) directly determined NO production during mucosal oxygenation. Non-immune stimulation of the colorectal mucosa with calcium ionophore (A23187), acetic acid, and ethanol induced a significant NO release in all groups and all biopsies. Whereas, immune-specific stimulation with allergens or anti-human IgE or -IgG antibodies did not produce significant release of NO in controls or IBD. Incubation with anti-human IgE antibodies or allergens produced a ninefold increase in histamine release in gastrointestinally mediated allergy (p<0.001), but anti-human IgE antibodies induced NO release in only 18% of the allergy patients. Histamine release in response to allergens or anti-human IgE antibodies did not correlate with NO release (r(2)=0.11, p=0.28). These data show that nonspecific calcium-dependent and toxic mechanisms induce NO release in response to a nonspecific inflammatory signal. In contrast, mechanisms underlying immune-specific stimuli do not induce NO production immediately.