Technique and complications of percutaneous endoscopic gastrostomy in children

Percutaneous endoscopic gastrostomy (PEG) is now a well-established technique in children. In this study of 63 children (mean age 7.8 years, youngest 2.4 months), technical problems associated with insertion of the gastrostomy tube, and complications related to the procedure, were analysed. Complications included wound infection, oesophageal injury (probably sustained during extraction of the guide wire) and symptomatic gastro-oesophageal reflux (GOR) occurring after PEG insertion. Many of these complications can be avoided or reduced in likelihood by refinements to the technique of insertion.

Comparison of EDTA and Apo-Lactoferrin with Lysozyme on the Growth of Foodborne Pathogenic and Spoilage Bacteria

Combinations of ethylenediaminetetraacetic acid (EDTA) or apo-lactoferrin (Apo-Lf) and lysozyme were evaluated for their antimicrobial effectiveness in ultra-high temperature pasteurized milk against Pseudomonas fluorescens , Salmonella typhimurium , Escherichia coli O157:H7, and Listeria monocytogenes . Neither P. fluorescens nor S. typhimurium growth was influenced by EDTA, Apo-Lf or lysozyme alone or in combinations. Escherichia coli O157:H7 was inhibited by EDTA alone, but no increase in antimicrobial effectiveness was noted in the presence of lysozyme. In contrast, EDTA and lysozyme had a significant interactive antimicrobial effect against L. monocytogenes . Apo-Lf, at concentrations up to 2.5 mg/ml, displayed similar inhibition patterns with lysozyme against the E. coli O157:H7 and L. monocytogenes however, the magnitude of inhibition was much less and of little practical significance. When evaluated over time, EDTA (1.5-2.5 mg/ml)-lysozyme (150 μg/ml) slowed growth of E. coli and was bactericidal to L monocytogenes . Apo-lactoferrin (15 mg/ml)-lysozyme (150 μg/ml) had little practical effect on E. coli growth but did slow growth of L. monocytogenes .

Survival of Selected Pathogenic Bacteria in White Pickled Cheese Made With Lactic Acid Bacteria or Antimicrobials

Effect of lactic acid bacteria starter culture, nisin, hydrogen peroxide, or potassium sorbate on Listeria monocytogenes , Staphylococcus aureus , and Salmonella typhimurium in white pickled cheese made from pasteurized milk with 4% salt and preserved in 4% brine solution at 4°C for 60 d was studied. The starter culture inhibited all three pathogens while antimicrobials did not. Beyond day 50 in curd and day 30 in brine solution, L. monocytogenes was not detected by direct plating in cheese with added starter culture. S. aureus was not detected after day 30 in curd and day 20 in brine solution in the same cheese. S. typhimurium was not detected after day 30 in cheese curd and was not detected in brine solution at any time with lactic acid bacteria starter culture added. The pH of brine solution of starter treatment dropped below 4.7 in all experiments, while antimicrobial treatments all had a pH >5.5.

Chemical Composition of and Listeria monocytogenes Survival in White Pickled Cheese

White pickled cheese was made from pasteurized milk with 8% salt and preserved in the whey at 4°C. About 5.0 log₁₀ CFU/ml cells of Listeria monocytogenes were inoculated into milk, and the survival of the pathogen was studied during the storage period. The chemical composition of the cheese was also determined. L. monocytogenes were not inhibited by 8% salt, but lactic acid bacteria were unable to grow and produce acid to inhibit L. monocytogenes . During ripening, the pH never decreased below 6.0. While fat, protein, total solids, and ash contents decreased in curd during ripening, the acidity and salt did not change. In cheese whey, fat, protein, acidity, and salt showed a slight increase, while total solids and ash contents were unchanged.

Homophobic attitudes and AIDS risk behavior of adolescents

Adolescents in the United States are increasingly knowledgeable about acquired immunodeficiency syndrome (AIDS), yet they are notoriously resistant to behavioral changes that would reduce their personal risk, such as practicing abstinence, using condoms, or careful selection of sexual partners. For the present study, we asked 80 heterosexual adolescents about their sexual behavior and intentions to avoid risky behavior, in conjunction with assessing their knowledge and attitudes concerning AIDS and AIDS-related issues. The results suggest that many adolescents do not feel vulnerable to AIDS because they still see AIDS as a Gay disease. Those who are most prejudiced against Gays are, on average, five times more willing to engage in indiscriminant sex as are the least prejudiced group; among males, this effect is even greater. In addition, highly prejudiced adolescents are twice as willing to have sex without using a condom. This study indicates the importance of dealing with homophobic attitudes in the context of AIDS education.

Influence of Altered Fatty Acid Composition on Resistance of Listeria monocytogenes to Antimicrobials

The sensitivity of Listeria monocytogenes Scott A and ATCC 19114 to antimicrobial compounds was altered when bacterial membrane lipid composition was modified by growth in the presence of added fatty acids. Analysis of cellular fatty acid composition by gas-liquid chromatography indicated that L. monocytogenes Scott A cells contained 0.97, 2.32, 0.81, and 0.72% (relative) of C14:0, C16:0, C18:0, and C18:l, respectively. In the presence of exogenously supplied C14:0, C16:0, C18:0, and C18:l, the percentages increased to 14.03, 30.92, 16.30, and 27.90%. Average MICs for L. monocytogenes Scott A and ATCC 19114 to sodium chloride, tertiary butylhydroquinone, methyl paraben, and propyl paraben were 10.0%, 81, 1406, and 544 μg/ml, respectively. Growing either strain in the presence of 50 μg/ml of either exogenously added C14:0 or C18:0 fatty acids increased their resistance to the four antimicrobial compounds. However, growth in the presence of C18:1 led to increased sensitivity to the antimicrobial agents. The results indicate that the susceptibility of L. monocytogenes to antimicrobial agents is related to the lipid composition of the cell membrane. Consequently, food preservation processes which alter fatty acid composition of L. monocytogenes could result in changes in antimicrobial susceptibility.

Lymphocyte production of gamma-interferon as a test for non-tuberculous mycobacterial lymphadenitis in childhood

Infection with Mycobacterium avium, M. intracellulare and M. scrofulaceum (MAIS) organisms in normal children may result in cervical lymphadenopathy. There is a poor response to anti-tuberculous therapy and surgical excision of infected nodes is necessary. The diagnosis therefore requires consideration in children with cervical lymphadenopathy. A simple in vitro assay is described which may be useful for diagnosis prior to excision. Whole blood is cultured with M. avium purified protein derivative. After 24 h the plasma is removed and the concentration of gamma interferon (IFN-gamma) quantified by a radioimmunometric assay. In a prospective study of 38 children with neck lesions, 16 showed MAIS organisms isolated from cultures of excised tissue. The level of IFN-gamma produced by peripheral blood lymphocytes from children in the MAIS group was significantly greater when compared with children having operations for neck lesions that were not due to MAIS organisms (P < 0.001).

Psychological morbidity in the first year after breast surgery

In this prospective study, the psychological morbidity associated with the treatment of breast cancer was assessed. The study population comprised all patients referred to one centre with a recently diagnosed breast lump, who were to undergo surgery. Psychological morbidity was assessed preoperatively and at 6 and 12 months postoperatively by modified Rotterdam Symptom Checklist. Three hundred and twenty patients completed all three questionnaires: 93 women undergoing mastectomy, 73 women having conservation therapy for breast cancer and 156 women having biopsy for benign breast disease. Patients with a breast malignancy smaller than 4 cm in diameter were treated by lumpectomy and radiotherapy, anti-oestrogen therapy or chemotherapy alone or in combination. Psychological morbidity among patients with malignant disease was significantly greater than that seen in the group with benign disease. Among cancer patients, a significant decrease in anxiety and depression occurred during the year following surgery. The study failed to demonstrate any psychological advantage associated with breast conservation.

Helicobacter pylori infection in children

Helicobacter pylori was sought prospectively by culture of antral biopsy, histology and serology (IgG and IgA) in 440 consecutive endoscopies on children to determine the prevalence, clinical presentation and histological features of H. pylori infection in our population. Twenty-eight patients had H. pylori (8% overall). The mean age of infected patients was significantly higher than that of non-infected patients (P less than 0.0001). No patient under 5 years of age had H. pylori isolated. Overall, there was no significant difference in clinical presentation between those with and those without H. pylori infection, but 23% of patients 5 and 26 years of age who presented with abdominal pain as the indication for their endoscopy had H. pylori isolated. Macroscopic changes ranged from no abnormality to frank ulceration, but the typical antral mamilliform changes were 100% predictive of infection. Fifty-eight per cent of patients with duodenal ulcers, but only 17% with gastric ulcers had H. pylori infection. Histological gastritis was present in 144 patients (including all H. pylori positive patients). None of the patients with another definable cause for gastritis had H. pylori isolated. In conclusion, H. pylori is an important cause of primary gastritis in our population, occurring in children over 5 years of age. Culture of an antral biopsy should be performed in children over this age undergoing endoscopy for the investigation of abdominal pain and, more particularly, in those with peptic ulceration.

Growth after gut resection for Crohn's disease

Seventeen children underwent 19 bowel resections as part of their management of Crohn's disease. Thirteen children had evidence of retardation of linear growth preoperatively, of whom 12 exhibited catch up growth, crossing at least one centile band, after resection. Seven of the 12 showed early signs of puberty at the time of resection and one child was regarded as being fully pubertal. All children were symptomatic before their surgery; at one year 11 were asymptomatic and three others were substantially improved. Surgical resection of localised Crohn's disease, followed by adequate nutritional support has lead to catch up growth and a prolonged symptom free period in most of our patients and this was not limited by their age or stage of puberty.

Influence of Bovine Lactoferrin on the Growth of Listeria monocytogenes

The influence of bovine lactoferrin (LF) and Apo-LF on growth of Listeria monocytogenes in Ultra-High Temperature (UHT) 2% fat milk was determined. The effect of LF was dependent upon both the degree of iron saturation and concentration. Before iron removal, LF was found to be approximately 52% saturated with iron; and at 23 and 46 mg/ml LF, minimal growth inhibition of L. monocytogenes was observed. Following dialysis, Apo-LF iron saturation was reduced to approximately 18%. At 15 and 30 mg/ml Apo-LF, a bacteriostatic effect against L. monocytogenes was observed. Inhibition of growth associated with Apo-LF was abolished when ferric ammonium citrate was added to saturate the iron binding sites of the Apo-LF.

Pancreatic beta cell proliferation in rabbits demonstrated by bromodeoxyuridine labeling

The purpose of the present study was to quantify beta cell proliferation in rabbits that had undergone subtotal beta cell ablation by labeling cell nuclei undergoing DNA synthesis with bromodeoxyuridine (BUdR). Ten New Zealand white rabbits were compared with five sham-operated controls. The beta cells in the head of the pancreas were destroyed by intravenous alloxan (200 mg/kg) while the tail of the pancreas was temporarily isolated from the systemic circulation by vascular occlusion clamps. On day 7, BUdR (70 mg/kg) was infused prior to killing to label newly synthesised DNA. Immunoperoxidase staining with anti-insulin sera and an anti-islet cell monoclonal antibody confirmed the absence of insulin-producing cells in the head of the pancreas. Beta cell proliferation within the islets of the tail of the pancreas was suggested by the appearance of cells undergoing mitosis and confirmed by BUdR labeling of cell nuclei detected with anti-BUdR monoclonal antibody. The mitotic index was significantly increased compared to control rabbits (p = 0.0235, Mann-Whitney U nonparametric test). This study demonstrates that the BUdR labeling can be used to document beta cell proliferation in vivo in the rabbit model after subtotal beta cell ablation.

Non-tuberculous mycobacterial lymphadenitis in children

Eighty-six children (44 males, 42 females) were identified as having non-tuberculous mycobacterial lymphadenitis. The diagnostic criteria were either culture of the organism from the affected lymph node (n = 68), or, when culture was negative, a positive skin test with non-tuberculous mycobacterial antigens and negative skin test responses to tuberculin purified protein derivative (PPD) in association with typical histological features (n = 18). All children had histopathological findings of granulomatous inflammation with caseation and/or acid-fast bacilli. Eighty-two percent of the children were under 5 years of age at presentation and 30% were less than 2 years old. Most (79%) were city dwellers. Lymph node enlargement had been present for less than 6 months in almost all children (97.5%) and was almost exclusively in the face and neck region (97%). Disease was confined to the involved lymph nodes in 56% but had extended beyond the confines of the infected node to form a collar stud abscess in 38% and 6% presented with a skin sinus. Extranodal extension did not show any statistically significant association with the duration of lymphadenopathy. The duration of lymphadenopathy had been greater in those children in whom an organism was not isolated on culture resected tissue (chi 2 = 10.07, P less than 0.01). All children were treated surgically, and recurrence occurred in five patients. This study describes the clinical and demographic characteristics of non-tuberculous mycobacterial lymphadenopathy in children in a population in which tuberculous adenitis is rare. Recognition of these features may allow earlier diagnosis and appropriate surgical therapy.

The Antimicrobial Activity of Phenolic Compounds Against Listeria monocytogenes and Their Effectiveness in a Model Milk System

The minimum inhibitory concentration (MIC) of several phenolic compounds against eight strains of Listeria monocytogenes in tryptose phosphate agar (TPA) was determined. Based upon concentration, the most effective compound was the phenolic antioxidant tertiary butylhydroquinone (TBHQ) which had a MIC of 64 μg/ml. Among the FDA approved food antimicrobials, the most effective was propyl paraben with a MIC of 512 μg/ml. Propyl paraben and TBHQ were then compared to potassium sorbate, a commonly used food antimicrobial, in a model milk system containing 10% nonfat milk solids. In this study, only one strain of the test microorganisms, Scott A, was used and two levels of inoculum, 10 and 1000 CFU/ml, were tested. As expected with the basic pH of the model system, both phenolic compounds were significantly more effective than potassium sorbate against L. monocytogenes at 35°C. Both compounds caused a noticeable increase in lag phase of this microorganism. There was about a three log difference in viable cell counts between propyl paraben and TBHQ and the control. The TBHQ was inconsistent in its activity. The inhibitory action of propyl paraben was not affected by the level of inoculum and had consistent activity throughout testing.

Haemolytic-uraemic syndrome after treatment with metronidazole

This paper describes the clinical features of six children who developed the haemolytic-uraemic syndrome after treatment with metronidazole. These children were older and were more likely to have undergone recent bowel surgery than are other children with this condition. While the involvement of metronidazole in the aetiology of the haemolytic-uraemic syndrome is not established firmly, the action of this drug in sensitizing tissues to oxidation injury and the reported evidence of oxidation changes in the haemolytic-uraemic syndrome suggest a possible link between metronidazole treatment and some cases of the haemolytic-uraemic syndrome.

Recovery of Clostridium perfringens from Food Samples Using an Oxygen-Reducing Membrane Fraction

Three strains of Clostridium perfringens were inoculated into different food products and their recovery rates on tryptose sulfite cycloserine (TSC) agar, with and without an oxygen-reducing membrane fraction (ORMF), were compared. Organisms were generally recovered in greater numbers using TSC+ORMF and aerobic incubation than with TSC and anaerobic incubation. Organisms inoculated into beef stew were subjected to heat and cold stress for various periods. In all instances, presence of ORMF in TSC and aerobic incubation resulted in greater recovery of viable C. perfringens than did TSC and anaerobic incubation. Of 35 uninoculated raw meat samples evaluated, C. perfringens was recovered from 22 using TSC+ORMF compared to 18 using TSC alone.

Early function concepts: their development and relation to certain mathematical and logical abilities

Cognition of functions (i.e., y = f(x)) has been identified as an achievement of early childhood. To investigate the development of function concepts and their relation to mathematical and logical abilities typically acquired during the age period of 5-7 years, 72 children in this age range were tested on nonnumerical function tasks (functions as exchange of properties, functions as displacement of positions, and functions as preservation of structure), numerical tasks (number conservation and arithmetic problems), and aspects of logical reasoning (class inclusion, class vicariance, and seriation). Orderly developmental trends were found in function task performance, with younger children manifesting limited success through trial-and-error strategies and older children achieving substantial success with anticipatory strategies. Moreover, certain function abilities were associated with the numerical domain, whereas others were associated with the logical domain. The findings are consistent with the developmental model of Piaget et al. according to which cognition of functions lays the groundwork for reversible operations, but also suggest that this development occurs through parallel processes within separate conceptual domains.

The role of the nurse-practitioner in breast care

Why have a nurse-practitioner in a breast center? This question is appropriate, although it may generate controversy. A hospital-based or freestanding breast diagnostic center that hires a nurse-practitioner is functioning outside the norm. It is unusual to find a nurse-practitioner providing services to women in a breast diagnostic center and representing that center in the community. Until recently, breast diagnostic centers have focused primarily on imaging. However, a breast center wishing to expand services to its patients and referring healthcare providers, as well as market its services to the surrounding community could employ such a nurse. Two issues need to be addressed when discussing the nurse-practitioner in the breast diagnostic center: defining a role for this nurse, which this article discusses, and supporting this role once it is in place.

Sacrococcygeal teratoma: has chemotherapy improved survival?

Case records of 57 patients (50 female, 7 male) with sacrococcygeal teratoma who were treated at the Royal Children's Hospital in Melbourne between 1948 and 1986 were reviewed. There were 40 benign and 19 malignant tumors; two patients had malignant recurrence following excision of a benign tumor. The majority of the benign lesions were readily excised; 80% of these patients presented under the age of 6 months. In contrast, 16 of the 19 patients with malignant disease presented after 6 months of age and 12 of these died. Before 1975, malignant lesions were treated with surgery or irradiation, and in a few patients, single-agent chemotherapy. No patients survived. In 1970, intensive multiagent chemotherapy was introduced, with planned delayed surgical resection, with or without postoperative irradiation. Three of five patients treated between 1976 and 1980 survive disease-free and are almost certainly cured. Modern therapy is with cisplatin-containing regimens, and while initial responses in six patients with extensive disease are impressive, it is too early to evaluate the impact of these newer programs on cure.

The partially diabetic pancreas: a histological study of a new animal model

An animal model in which part of the pancreas was made diabetic due to almost total loss of insulin-secreting B cells, while the remainder of the gland remained normal, is described. In rabbits, a vascular clamp was placed across the junction of the body and tail of the pancreas, thus occluding the circulation to the tail. Alloxan (200 mg/kg) was injected i.v., and 4 min later dextrose (0.5 g/kg) was given by the same route. After a further 2 min the clamp was removed. Thirty-four animals were studied, 17 of which died in the first postoperative week of surgical complications or of alloxan-induced toxicity to the liver and kidneys. The survivors were killed between 4 and 12 weeks after surgery and were not metabolically diabetic. They had a virtually complete absence of B cells but a normal population of A, D, and PP cells in the head and body of the pancreas. The islets in the tail of the pancreas appeared entirely normal. This model appears suitable for studying the effects of locally produced insulin on pancreatic exocrine function in metabolically normal animals.

Lethal effect of butylated hydroxyanisole as related to bacterial fatty acid composition

Bacillus cereus, Clostridium perfringens, Staphylococcus aureus, Pseudomonas fluorescens, Pseudomonas fragi, Escherichia coli, and Salmonella "anatum" were challenged with butylated hydroxyanisole (BHA). Susceptibility was measured as the concentration of BHA required to cause a 90% reduction in bacterial survivors. Staphylococcus aureus LP and P. fragi were two of the most resistant species examined; C. perfringens and P. fluorescens were the most susceptible. Gram stain reaction was found not to be a strict indicator of bacterial susceptibility to BHA. There was no obvious relationship between individual fatty acids and susceptibility. The ratio of saturated to unsaturated fatty acids in the total lipid fraction of only the gram-positive species was related to susceptibility. The ratios of saturated to unsaturated fatty acids of other fractions were not related to susceptibility.

Growth characteristics of selected fungi on polyvinyl chloride film

The objective of this study was to determine if plasticized polyvinyl chloride film would support the growth of any of nine species of fungi. The film was suspended in distilled water with no nutrients or with glucose or ammonium sulfate. Spores of each of the test species were inoculated into the suspension medium, and the mixture was incubated at 30 degrees C for up to 18 weeks. Most species were found to be capable of utilizing the film for carbon or nitrogen when the other nutrient was supplied. Only two species, Aspergillus fischeri and Paecilomyces sp., were found to be capable of utilizing components of the film without added nutrients. Components of the polyvinyl chloride film were then incorporated into mineral salts medium to determine if these components could serve as carbon sources in the presence of ammonium nitrate. The only component found to be utilized by all the fungi as a carbon source was epoxidized oil, a plasticizer-stabilizer. Calcium-zinc stearate was an available carbon source for all except the Penicillium and Verticillium strains. The only other component utilized was a stearamide, which was metabolized solely by the Aspergillus sp. Only the stearamide contained enough nitrogen to serve as a primary source in the film. The compound, however, did not support growth of fungi in the presence of glucose. It was theorized that either the nitrogen of the stearamide was more readily available to the fungi in the whole film due to the presence of trace nutrients or the nitrogen was supplied by exogenous sources.

Use of Sodium Substitutes in Cottage Cheese and Buttermilk

Twenty-four market samples of cottage cheese had an average sodium concentration of 4.91 ± 1.20 mg/g. Two samples of cottage cheese formulated to contain 1.1% "Lite" and Zyest, and having sodium concentrations of 3.23 and 2.54 mg/g had significantly lower flavor scores than a sample containing 1.4% NaCl and having 6.25 mg of Na/g. The Standard Plate Counts and the yeast and mold counts on the cottage cheese after storing 10 d at 4°C were not different between samples containing salt, salt substitute or salt substitute plus a dry yeast preparation. Psychrotrophic bacteria were more numerous in the samples containing the yeast preparation. Four samples of buttermilk containing .015% "Zyest 45-F" and .25% NaCl, .25% "Lite" and .015% "Zyest 45-F", .25% NaCl, or .25% "Lite" had comparable flavor scores. The sodium concentrations of the four samples were 1.096, .793, 1.125 and .771 mg/g, respectively. The growth of yeasts and molds in samples containing "Zyest 45-F" and "Lite" was slightly but not significantly greater than the other three samples. Psychrotrophic counts on buttermilk after 7 d of storage at 4°C were much lower than the original counts, but were not influenced by the additives used.