Clinical application of a simple HPLC method for the sugar intestinal permeability test

A new high pressure liquid chromatography (HPLC) method has been used to measure urinary sugar levels for the intestinal permeability test with cellobiose and mannitol (C/M test). Urinary specimens have been prepared by simple filtration through a Millipore membrane. The method is highly sensitive (minimal detectable concentration of urinary sugars = 0.01 mg/ml) and reproducible (coefficient variation between samples = 0.47% for cellobiose and 0.25% for mannitol). By this method a C/M test has been performed in a large series of gastroenterological patients. High values of mean urinary C/M percentage recovery ratio (C/M%) were found in 30 children with active gluten-sensitive enteropathy compared with controls (0.42 +/- 0.66 versus 0.014 +/- 0.005). In 44 treated celiacs and 34 children with chronic nonspecific diarrhea the mean C/M%s were 0.027 +/- 0.018 and 0.021 +/- 0.012, respectively. The results of this study confirm that the C/M test is a valuable investigation in the diagnostic studies of children with chronic diarrhea. The simple HPLC method described for the determination of urinary sugar levels should allow a wider diffusion of this test.

Changes of fluorescence anisotropy in plasma membrane of human polymorphonuclear leukocytes during the respiratory burst phenomenon

Steady state fluorescence anisotropy (rs) of TMA-DPH was measured to study the effect of respiratory burst activation with PMA, FMLP, and PAF on the physico-chemical structure of PMNs plasma membrane. Our results show a significant increase in rs during the respiratory burst activation. In the presence of NADPH-oxidase inhibitor DPI, only PAF induces changes in rs values. This suggests a non-specific effect of PAF on plasma membrane. Azide, which induces a supranormal release of H2O2, fails to increase the basal rs value after activation. Moreover, the catalase does not abolish the increase in rs induced upon activation. This rules out the possibility that changes of rs during the respiratory burst activation are attributed mainly to H2O2 release. We conclude that multiple processes accompanying the respiratory burst activation are responsible for the changes in the physico-chemical properties of PMNs plasma membrane.

[The pediatrician and anorexia nervosa. Biological aspects]

Describing a case of anorexia nervosa the Authors review the clinical manifestations and organic alterations of this disease. The Authors point out the signs and symptoms which will usually suggest a diagnosis of anorexia nervosa. The course of the disease is monitored by the metabolic and hormonal analyses and the accompanying psychological features are underlined. The Authors present their therapeutic approach and emphasize the role of psychiatric treatment.

Alterations of the respiratory burst of polymorphonuclear leukocytes from diabetic children. A chemiluminescence study

The respiratory burst of polymorphonuclear leukocytes was investigated in 24 children with insulin dependent diabetes mellitus and 24 healthy controls. This oxygen dependent, membrane associated process generates a number of toxic oxygen metabolites which are implicated in the pathogenesis of endothelial damage. The activity of polymorphonuclear leukocytes was studied in terms of luminol amplified chemiluminescence. It was found that the resting luminol amplified chemiluminescence activity of isolated polymorphonuclear leukocytes from diabetic children was significantly higher than that of controls (342,000 +/- 174,000 cpm vs. 165,000 +/- 82,000 cpm, p less than 0.01). The addition of respiratory burst inhibitors caused a significant reduction of basal chemiluminescence (greater than 80%). When the ratio of phorbol myristate acetate stimulated activity to basal activity was calculated and used as an activation index, it was found to be significantly reduced in diabetics relative to controls (4.29 +/- 2.46 vs. 8.34 +/- 3.21, p less than 0.01). These observations suggest that increased release of toxic oxygen metabolites from polymorphonuclear leukocytes in diabetic subjects may play a role in the development of diabetic angiopathies.

Mild form of Jeune syndrome in two sisters

Jeune syndrome is characterized by respiratory distress, osseous dysplasia, and short stature. Patients generally die during the first months of life. However, some cases with milder clinical manifestations have been described; these cases show characteristic renal involvement of different severity. The authors report on two cases of the mild form of Jeune syndrome in sisters.

Magnetic resonance imaging in the malformative syndromes with mental retardation

We reported on thirteen children affected with malformative syndromes associated with mental retardation. MRI examination showed in all of them different types of anomalies; agenesis of corpus callosum, ventricular dilatation and cerebral matter alterations were the most frequent findings. The authors give a brief description of the clinical reports and of the anomalies observed with MRI; they conclude that MRI seems to be a valuable tool especially for the study of the alterations of the cerebral matter and their correlation with mental retardation.

Scanning electron microscopy of the small intestine mucosa in children with celiac disease after long-term dietary treatment

Jejunal mucosal specimens from twenty children with celiac disease were studied by light microscopy (LM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM) after one year of dietary treatment. An ultrastructural morphometric study was performed in five patients who had an intestinal permeability (IP) test. Seventeen patients were tested for serum antigliadin antibodies (AGA). In ten children, in whom LM showed partial villous atrophy, SEM and TEM examination confirmed the lesion. In the second group (10 children) with normal morphology at routine LM, SEM showed lesions of variable degree in 70% of cases. The morphological ultrastructural investigation showed good correlation with the immunological and functional data (IP test): ultrastructural damage of the jejunal mucosa after one year of a gluten-free diet was found in patients with positive serum AGA and an abnormal IP test. Furthermore, the morphometric study of the ultrastructural alterations allowed a quantitative, closer correlation between morphological and functional data. Our results suggest: 1) SEM and TEM investigations offer additional and more complete information on celiac patients, over LM alone. 2) The morphometric evaluation of the ultrastructural alterations highlights quantitative and reproducible correlations between morphological and clinical data, not strengthened by the subjective, qualitative study.

[Study of the SNC using MRI in a case of Lowe's syndrome]

A case of Lowe syndrome is reported. This syndrome is characterized by ocular, cerebral and renal defects. MRI investigation showed severe thickness of the corpus callosum and defective cerebral development.

Modifications of erythrocyte membrane fluidity of in vivo functionally aged human erythrocytes

The process of red blood cell senescence in the blood stream results in many changes in their physical and biochemical properties. In this work we have studied the physico-chemical state of erythrocyte membranes prepared from 5 subpopulations of erythrocytes of different age by using the fluorescence technique. Membrane fluidity has been evaluated by the fluorescence polarization of 1,6-diphenyl-1,3,5-hexatriene (DPH) and a further study of the fluorescence decay of this probe has been performed by multifrequency phase and modulation fluorometry. DPH fluorescence polarization is significantly increased in the membranes prepared from the youngest fraction of erythrocytes, indicating a decreased fluidity without any significant change in DPH fluorescence decay.

[Progressive pseudorheumatoid arthropathy in childhood (late spondylo-epiphysial dysplasia with progressive arthropathy). Description of a case]

The progressive pseudorheumatoid arthropathy of childhood is a very rare disorder that follows an autosomal recessive mode of inheritance, and which can be framed in the group of the spondyloepiphyseal dysplasia tarda. This affection is characterized by specific radiological anomalies and by clinical signs resembling an inflammatory disease, with the normality of the routine laboratory studies. The authors describe a case recently come to their attention.

Oculo-cerebro-cutaneous syndrome: description of a new case

A newborn girl is described with the following multiple congenital anomalies: an orbital cyst, cutaneous appendages, focal hypo-aplasia of the skin and multiple cerebral cysts. This case of oculo-cerebro-cutaneous syndrome is compared with four previously published cases.

Altered properties of platelet membrane in childhood obesity

Using 1-(4-trimethylammoniumphenyl)-6-phenyl-1,3,5,hexatriene (TMA-DPH) as fluorescent probe, we have studied platelet membrane fluidity and thrombin induced exocytosis in ten obese children and fifteen controls. Our results indicate a decrease of membrane fluidity, as shown by an increase of fluorescence anisotropy, in platelets from obese patients in comparison with the controls. Associated with the changes in membrane fluidity, platelets of obese subjects showed a decreased sensitivity to thrombin stimulation.

Changes of erythrocyte membrane fluidity associated with childhood obesity: a molecular study using fluorescence spectroscopy

Fluorescence polarization of 1,6-diphenyl-1,3,5-hexatriene has been used to investigate the physical state of erythrocyte membranes from 36 obese children in absence of endocrine and metabolic disorders involving alterations of blood lipid pattern. A decrease of membrane fluidity, as shown by an increase of fluorescence polarization, was evident in obese subjects in comparison with the controls. The study of membrane composition has revealed an increase of cholesterol content and of cholesterol to phospholipid molar ratio, both being positively correlated with the observed changes of membrane fluidity. Moreover a correlation of membrane fluidity is also observed with body-mass index and plasma cholesterol levels. The results are discussed in the light of the possible use of erythrocyte membrane as a model to detect early alterations in the exchanges between erythrocyte membrane and lipoproteins in obesity.

Unresponsive enteropathy associated with circulating enterocyte autoantibodies in a boy with common variable hypogammaglobulinemia and type I diabetes

A 13-year-old boy with common variable hypogammaglobulinemia and type I diabetes developed a severe enteropathy that proved to be unresponsive to any treatment, including total parenteral nutrition. No evidence of known etiologies of malabsorption and/or secretory diarrhea was found in this subject. A high titer of complement-fixing enterocyte autoantibody was persistently found in the patient's serum. These features suggest that the enteropathy of this primarily immunodeficient subject had an autoimmune origin. A cycle of cyclophosphamide failed to show any amelioration of the diarrhea or a significant decrease in the autoantibody titer.

Early indicators of nephrotoxicity: comparison of two antibiotics

The aim of the study was the evaluation of the clinical efficacy and the kidney tolerance of ceftazidime in comparison with netilmicin in pediatric patients. Forty subjects, ranging from six months to ten years of age were randomly allocated in two groups and treated either with ceftazidime (80-100 mg/kg/day) or netilmicin (6 mg/kg/day). A control group of twenty subjects was selected in order to establish the normal values of beta 2-microglobulin and urinary enzymes excretion. beta 2-microglobulin, enzymuria, cylindruria and urinary osmolability were estimated, as well as hematological parameters. Ceftazidime was as efficacious as netilmicin in the clinical outcome and in addition it did not cause any pathological change in early markers of tubular damage.

Clinical application of a new simple method for the identification of mucopolysaccharidoses

The clinical application of a new method for the quantitative determination of urinary glycosaminoglycans (GAGs) is presented. 115 normal subjects and 44 patients affected by different types of mucopolysaccharidoses (MPSo-ses) have been studied by this method in comparison with the conventional borate-carbazole method. All patients showed an urinary GAG excretion well above the normal subjects. In particular, patients affected by Morquio syndrome showed values well beyond the normal range; on the contrary, with the borate-carbazole method, 6 out of 7 patients had borderline values of urinary GAGs. The new method is also more rapid and easier to perform than conventional methods.

Plasma zinc levels in children with chronic diarrhoea

We measured the plasma zinc concentration in a group of children with chronic diarrhoea. Fifteen patients with untreated coeliac disease had a mean plasma zinc level significantly lower than that of healthy children (69 micrograms/dl vs 96 micrograms/dl). In patients with chronic post-enteritic diarrhoea (n = 70) the mean plasma zinc level was in the normal range (100 micrograms/dl). The latter result suggests that our country a secondary zinc deficiency is not a feature of chronic post-enteritic diarrhoea.

Ultrastructural findings in the jejunal mucosa of children with IgA deficiency

The primary aim of this work was to investigate the ultrastructural morphology of the small intestinal mucosa in children affected by selective IgA deficiency (SIgAD). Absorptive tests and intestinal biopsies were performed in a group of nine children with SIgAD, none of them presenting with diarrhea. Biopsy specimens were processed for routine histology and scanning or transmission electron microscopy (SEM and TEM). By light microscopy, the jejunal mucosa appeared normal in all but one patient with patchy villous atrophy. By SEM, two further biopsies showed small areas of flat mucosa surrounded by villous ridges of nearly normal height. By TEM, four out of the nine mucosal specimens showed degenerative changes of the surface epithelium, including enlargement of the mitochondria, apical accumulation of primary and secondary lysosomes, and shortening and branching of the microvilli. These findings suggest that the small intestinal mucosa of children with SIgAD often shows pathological changes, some of which are recognizable only at the ultrastructural level. The study of biopsy specimens by SEM seems to be a useful diagnostic tool when patchy mucosal damage may occur, as in some of our patients with SIgAD.