Microbes and Mental Illness: Past, Present, and Future

A review of the association between microbes and mental illness is performed, including the history, relevant definitions, infectious agents associated with mental illnesses, complex interactive infections, total load theory, pathophysiology, psychoimmunology, psychoneuroimmunology, clinical presentations, early-life infections, clinical assessment, and treatment. Perspectives on the etiology of mental illness have evolved from demonic possession toward multisystem biologically based models that include gene expression, environmental triggers, immune mediators, and infectious diseases. Microbes are associated with a number of mental disorders, including autism, schizophrenia, bipolar disorder, depressive disorders, and anxiety disorders, as well as suicidality and aggressive or violent behaviors. Specific microbes that have been associated or potentially associated with at least one of these conditions include Aspergillus, Babesia, Bartonella, Borna disease virus, Borrelia burgdorferi (Lyme disease), Candida, Chlamydia, coronaviruses (e.g., SARS-CoV-2), Cryptococcus neoformans, cytomegalovirus, enteroviruses, Epstein-Barr virus, hepatitis C, herpes simplex virus, human endogenous retroviruses, human immunodeficiency virus, human herpesvirus-6 (HHV-6), human T-cell lymphotropic virus type 1, influenza viruses, measles virus, Mycoplasma, Plasmodium, rubella virus, Group A Streptococcus (PANDAS), Taenia solium, Toxoplasma gondii, Treponema pallidum (syphilis), Trypanosoma, and West Nile virus. Recognition of the microbe and mental illness association with the development of greater interdisciplinary research, education, and treatment options may prevent and reduce mental illness morbidity, disability, and mortality.

Imaging analysis of Bartonella species in the skin using single-photon and multi-photon (second harmonic generation) laser scanning microscopy

We demonstrate Bartonella spp are abundant in skin lesions resembling striae distensae. These striae distensae-like lesions, coincidental with sudden onset of neuropsychiatric symptoms, indicate testing for suspected Bartonella spp. infection.

Evaluation of the Cunningham Panel™ in pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS): Changes in antineuronal antibody titers parallel changes in patient symptoms

OBJECTIVE

This retrospective study examined whether changes in patient pre- and post-treatment symptoms correlated with changes in anti-neuronal autoantibody titers and the neuronal cell stimulation assay in the Cunningham Panel in patients with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection (PANDAS), and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS).

METHODS

In an analysis of all tests consecutively performed in Moleculera Labs' clinical laboratory from April 22, 2013 to December 31, 2016, we identified 206 patients who were prescribed at least one panel prior to and following treatment, and who met the PANDAS/PANS diagnostic criteria. Patient follow-up was performed to collect symptoms and treatment or medical intervention. Of the 206 patients, 58 met the inclusion criteria of providing informed consent/assent and documented pre- and post-treatment symptoms. Clinician and parent-reported symptoms after treatment or medical intervention were categorized as "Improved/Resolved" (n = 34) or "Not-Improved/Worsened" (n = 24). These were analyzed for any association between changes in clinical status and changes in Cunningham panel test results. Clinical assay performance was also evaluated for reproducibility and reliability.

RESULTS

Comparison of pre- and post-treatment status revealed that the Cunningham Panel results correlated with changes in patient's neuropsychiatric symptoms. Based upon the change in the number of positive tests, the overall accuracy was 86%, the sensitivity and specificity were 88% and 83% respectively, and the Area Under the Curve (AUC) was 93.4%. When evaluated by changes in autoantibody levels, we observed an overall accuracy of 90%, a sensitivity of 88%, a specificity of 92% and an AUC of 95.7%. Assay reproducibility for the calcium/calmodulin-dependent protein kinase II (CaMKII) revealed a correlation coefficient of 0.90 (p < 1.67 × 10^-6) and the ELISA assays demonstrated test-retest reproducibility comparable with other ELISA assays.

CONCLUSION

This study revealed a strong positive association between changes in neuropsychiatric symptoms and changes in the level of anti-neuronal antibodies and antibody-mediated CaMKII human neuronal cell activation. These results suggest there may be clinical utility in monitoring autoantibody levels and stimulatory activity against these five neuronal antigen targets as an aid in the diagnosis and treatment of infection-triggered autoimmune neuropsychiatric disorders. Future prospective studies should examine the feasibility of predicting antimicrobial and immunotherapy responses with the Cunningham Panel.

Bartonella henselae Bloodstream Infection in a Boy With Pediatric Acute-Onset Neuropsychiatric Syndrome

Background:

With the advent of more sensitive culture and molecular diagnostic testing modalities, Bartonella spp. infections have been documented in blood and/or cerebrospinal fluid specimens from patients with diverse neurological symptoms. Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by an unusually abrupt onset of cognitive, behavioral, or neurological symptoms. Between October 2015 and January 2017, a 14-year-old boy underwent evaluation by multiple specialists for sudden-onset psychotic behavior (hallucinations, delusions, suicidal and homicidal ideation).

Methods:

In March 2017, Bartonella spp. serology (indirect fluorescent antibody assays) and polymerase chain reaction (PCR) amplification, DNA sequencing, and Bartonella enrichment blood culture were used on a research basis to assess Bartonella spp. exposure and bloodstream infection, respectively. PCR assays targeting other vector-borne infections were performed to assess potential co-infections.

Results:

For 18 months, the boy remained psychotic despite 4 hospitalizations, therapeutic trials involving multiple psychiatric medication combinations, and immunosuppressive treatment for autoimmune encephalitis. Neurobartonellosis was diagnosed after cutaneous lesions developed. Subsequently, despite nearly 2 consecutive months of doxycycline administration, Bartonella henselae DNA was PCR amplified and sequenced from the patient’s blood, and from Bartonella alphaproteobacteria growth medium enrichment blood cultures. B henselae serology was negative. During treatment with combination antimicrobial chemotherapy, he experienced a gradual progressive decrease in neuropsychiatric symptoms, cessation of psychiatric drugs, resolution of Bartonella-associated cutaneous lesions, and a return to all pre-illness activities.

Conclusions:

This case report suggests that B henselae bloodstream infection may contribute to progressive, recalcitrant neuropsychiatric symptoms consistent with PANS in a subset of patients.

Alert for Perioperative Visual Loss: An Unusual Presentation of an Orbital Haemangioma during Spinal Surgery

A 62-year-old man with a history of non-insulin-dependent diabetes mellitus, hypertension and obesity, presented for elective lumbar laminectomy for spinal canal stenosis. Twenty minutes after placement in the prone position, he developed left orbital proptosis. The surgery was deferred and a subsequent CT scan showed an orbital haemangioma. This case highlights the importance of meticulous attention to eye-care for patients in the prone position.

The Role of Infection and Immune Responsiveness in a Case of Treatment-Resistant Pediatric Bipolar Disorder

A case of psychotropic-resistant pediatric bipolar disorder is presented. Both awareness and proper treatment of previously unrecognized infections and their effects on the immune system were very important in stabilizing the patient's psychiatric symptoms.

Mulga snake (Pseudechis australis) envenoming: a spectrum of myotoxicity, anticoagulant coagulopathy, haemolysis and the role of early antivenom therapy - Australian Snakebite Project (ASP-19)

CONTEXT

Mulga snakes (Pseudechis australis) are venomous snakes with a wide distribution in Australia. Objective. The objective of this study was to describe mulga snake envenoming and the response of envenoming to antivenom therapy.

MATERIALS AND METHODS

Definite mulga bites, based on expert identification or venom-specific enzyme immunoassay, were recruited from the Australian Snakebite Project. Demographics, information about the bite, clinical effects, laboratory investigations and antivenom treatment are recorded for all patients. Blood samples are collected to measure the serum venom concentrations pre- and post-antivenom therapy using enzyme immunoassay.

RESULTS

There were 17 patients with definite mulga snake bites. The median age was 37 years (6-70 years); 16 were male and six were snake handlers. Thirteen patients had systemic envenoming with non-specific systemic symptoms (11), anticoagulant coagulopathy (10), myotoxicity (7) and haemolysis (6). Antivenom was given to ten patients; the median dose was one vial (range, one-three vials). Three patients had systemic hypersensitivity reactions post-antivenom. Antivenom reversed the coagulopathy in all cases. Antivenom appeared to prevent myotoxicity in three patients with high venom concentrations, given antivenom within 2 h of the bite. Median peak venom concentration in 12 envenomed patients with samples was 29 ng/mL (range, 0.6-624 ng/mL). There was a good correlation between venom concentrations and the area under the curve of the creatine kinase for patients receiving antivenom after 2 h. Higher venom concentrations were also associated with coagulopathy and haemolysis. Venom was not detected after antivenom administration except in one patient who had a venom concentration of 8.3 ng/ml after one vial of antivenom, but immediate reversal of the coagulopathy.

DISCUSSION

Mulga snake envenoming is characterised by myotoxicity, anticoagulant coagulopathy and haemolysis, and has a spectrum of toxicity that is venom dose dependant. This study supports a dose of one vial of antivenom, given as soon as a systemic envenoming is identified, rather than waiting for the development of myotoxicity.

Is Doppler ultrasonography essential for hemorrhoidal artery ligation?

BACKGROUND

Doppler ultrasonography enables accurate identification of the terminal branches of the superior rectal artery prior to hemorrhoidal artery ligation (HAL). However, since the positions of these branches have been found to be relatively constant, the question arises as to the necessity of ultrasonography for their identification. The aim of the current study was to examine the positions of all arteries identified and ligated during the HAL procedure.

METHODS

We recorded the position of all arteries located and ligated in 135 consecutive patients who underwent the HAL procedure during the years 2003 to 2006.

RESULTS

In all patients, 6-8 terminal arterial branches were located above the dentate line. In 102 (76 %) patients, terminal branches were located in all 6 of the odd-numbered clock positions around the anus (1, 3, 5, 7, 9, and 11 o'clock in the lithotomy position). If we had ligated arteries only at these odd-numbered clock positions, without using Doppler ultrasonography, we would have located all the arteries in 96 (71 %) of our patients.

CONCLUSIONS

The number and location of arterial branches of the superior rectal artery are relatively constant. Nevertheless, if, Doppler ultrasonography had not been performed and, ligation in the HAL procedure had been at the odd-numbered clock positions only, then at least one artery would have been missed in 29 % of our patients.

Five-year follow-up of Doppler-guided hemorrhoidal artery ligation

BACKGROUND

Doppler-guided hemorrhoidal artery ligation (DGHAL) was described as lower risk and a less painful alternative to hemorrhoidectomy. We report our experience and 5-year follow-up with this procedure.

METHODS

Between May 2003 and December 2004, 100 patients with symptomatic Grade II or III hemorrhoids underwent ultrasound identification and ligation of 6-8 terminal branches of the superior rectal artery above the dentate line by a single surgeon using local, regional, or general anesthesia. There were 42 men and 58 women (mean age 42 years, median duration of symptoms 6/3 years). A 10-point visual analog scale was used for postoperative pain scoring. Surgical and functional outcome was assessed at 6 weeks and 3 and 12 months after surgery, with long-term follow-up by a telephone questionnaire at 5 years after the procedure.

RESULTS

The mean operative time was 19 min. Local anal block combined with intravenous sedation (n = 93) or general or spinal (n = 7) anesthesia was used. Only 5 patients were hospitalized overnight. There was no urinary retention, bleeding, or mortality in the immediate postoperative period. The mean pain score decreased from 2.1 at 2 h postoperatively to 1.3 on the first postoperative day. All patients had complete functional recovery by the third postoperative day. Ninety-six patients completed 12 months of follow-up. Eighty-five of these patients (89%) remained asymptomatic at 12 months, though this number dropped to 67/92 (73%) at 5 years.

CONCLUSIONS

Long-term follow-up confirms the effectiveness of the DGHAL procedure for treatment for Grade II hemorrhoids. The DGHAL procedure alone seems less effective for Grade III hemorrhoids.

Outcome of repeated stapler haemorrhoidopexy for recurrent prolapsing haemorrhoids

AIM

Stapled haemorrhoidopexy (SH) is associated with minor postoperative pain and high overall satisfaction rates. Some patients will have persistent or recurrent symptoms requiring re-intervention.

METHOD

All patients who underwent SH for grade III internal haemorrhoids and required a second SH (2005-2008) were studied. Grade IV patients were excluded. Data on surgical technique, postoperative pain, complications, time to first bowel movement, functional recovery and suspected reason for first SH failure were retrieved from medical records. Similar data were collected for the second procedure at four postoperative follow-up visits.

RESULTS

Twelve patients were enrolled. The mean time to recurrent symptoms was 15 months. The indications for repeated surgery were bleeding, prolapse, and pruritus w/wo discharge. Recurrence was attributed to a too high staple line in the first procedure (n = 4) and an incomplete resected ring (n = 1). The median operative time of the second procedure was 24 min (17-29) and the median follow up was 20 ± 4.3 months (15-30). Repeat SH was associated with higher pain scores, more analgesic requirements, and longer recovery period compared to the first procedure. There were no early or late postoperative complications. Histological examination of the 12 tissue doughnuts resected during the second SH showed no smooth muscle fibres in any of the patients. After 12 months of follow up, 10 patients with repeated SH remained asymptomatic, while 2 had recurrent bleeding.

CONCLUSION

Repeat SH can be performed safely and reliably without risk of complications, but the second SH is associated with more pain and longer recovery time.

Outcome of stapled hemorrhoidopexy versus doppler-guided hemorrhoidal artery ligation for grade III hemorrhoids

PURPOSE

To evaluate the long-term results, early and late complication rates, and overall satisfaction of patients with grade III hemorrhoids treated by stapled hemorrhoidopexy (SH) or Doppler-guided hemorrhoidal artery ligation (DGHAL).

METHODS

Operative and follow-up patients' data were prospectively collected for patients undergoing either SH or DGHAL by a single surgeon during a 2-year period. A retrospective comparison between patients' outcome operated by one of the two methods was made based on this data. Clinical data on postoperative pain, analgesic requirements, time to first bowel movement and functional recovery were collected at five postoperative follow-up visits (1 and 6 weeks, 6, 12, and 18 months). Data on patient satisfaction, recurrence of hemorrhoidal symptoms and further treatments were obtained by a standardized questionnaire that was conducted during the last visit 18 months postoperatively.

RESULTS

A total of 63 patients underwent SH (aged 52 ± 3.2 years) and 51 patients underwent DGHAL (aged 50 ± 7.3 years). DGHAL patients experienced less postoperative pain as scored by pain during bowel movement (2.1 ± 1.4 vs. 5.5 ± 1.9 for SH), and required fewer analgesics postoperatively. Hospital stay, time to first bowel movement, and complete functional recovery were also significantly shorter for the DGHAL patients. Nine DGHAL patients (18%) suffered from persistent bleeding or prolapses and required additional treatment compared with 2 (3%) patients in the SH group. SH patients reported greater satisfaction compared with DGHAL patients at 1 year postoperatively.

CONCLUSION

Both SH and DGHAL are safe procedures and have similar effectiveness for treating grade III hemorrhoids. DGHAL is less painful and provides earlier functional recovery, but is associated with higher recurrence rates and lower satisfaction rates compared with SH.

Neophobia in the foraging-site selection of a neotropical migrant bird: An experimental study

I hand-raised chestnut-sided warblers (Dendroica pensylvanica) in a room with eight experimental microhabitats; the microhabitats were removed after 6 weeks. I then measured the response of the warblers to the eight "natal" and eight "novel" microhabitats in two experiments conducted 2 and 4 months after removal. Chestnut-sided warblers responded with decreased feeding latency (neophobia) and a greater preference for foraging at the natal microhabitats. I suggest that an ontogenetic increase in neophobia restricts chestnut-sided warblers to foraging at microhabitats most similar to those experienced as juveniles.

Recognizing the Similarities and Differences Between Pediactric Bipolar Disorder (PBPD) and Autistic Spectrum Disorders (ASD)

Recent studies have indicated a significant increase in the number of children diagnosed with psychiatric disorders. This is especially true for pediatric bipolar disorder and autistic spectrum disorders this includes autism, Asperger's and pervasive developmental disorder not otherwise specified. The purpose of this presentation is to define these two disorders and help elucidate the overlap and the differences between them, as well as help elucidate when a youngsters has both.

On the surface these two diagnoses can look quite similar. In both the child can show signs of inappropriate and an excessive of response to frustration, overreaction to sensory stimuli, and rigid behavior with difficulty accepting change and transitions, as well as an intense and obsessional interest in certain topics. Sleep difficulties, limited eating repetitore, problems with inattention, poor social skills etc. are also common to both disorders. The number of children that have both disorders is still unknown but clinically appears more common than previously believed. The importance of recognizing the coexistence of both disorders can have a major effect on the approach to treatment and the individual's resultant level of functioning.

This presentation will address the following question:1.

Eruptions arising from tidally controlled periodic openings of rifts on Enceladus

In 2005, plumes were detected near the south polar region of Enceladus, a small icy satellite of Saturn. Observations of the south pole revealed large rifts in the crust, informally called 'tiger stripes', which exhibit higher temperatures than the surrounding terrain and are probably sources of the observed eruptions. Models of the ultimate interior source for the eruptions are under consideration. Other models of an expanding plume require eruptions from discrete sources, as well as less voluminous eruptions from a more extended source, to match the observations. No physical mechanism that matches the observations has been identified to control these eruptions. Here we report a mechanism in which temporal variations in tidal stress open and close the tiger-stripe rifts, governing the timing of eruptions. During each orbit, every portion of each tiger stripe rift spends about half the time in tension, which allows the rift to open, exposing volatiles, and allowing eruptions. In a complementary process, periodic shear stress along the rifts also generates heat along their lengths, which has the capacity to enhance eruptions. Plume activity is expected to vary periodically, affecting the injection of material into Saturn's E ring and its formation, evolution and structure. Moreover, the stresses controlling eruptions imply that Enceladus' icy shell behaves as a thin elastic layer, perhaps only a few tens of kilometres thick.

How much acetaminophen do paediatricians prescribe? A survey among Israeli paediatricians

OBJECTIVE

To describe the current practice of Israeli paediatricians regarding acetaminophen dosing.

METHODS

A cross-sectional survey among 200 paediatricians. The paediatricians were questioned of the recommended dose of acetaminophen, and whether they give prescriptions for acetaminophen and instruct their patients how to use it.

RESULTS

The response rate was 36%. When asked on the recommended dose of acetaminophen, 30 (42%) physicians gave doses different from the dose recommended by the Israeli formulary. Thirty (42%) of the paediatricians answered that they usually or always give prescriptions for antipyretics.

CONCLUSIONS

A large percentage of Israeli paediatricians do not provide parents proper instructions regarding the correct dosing of acetaminophen.

Treatment of pilonidal sinus disease using fibrin glue as a sealant

BACKGROUND

Complete excision is the preferred treatment for pilonidal sinus disease. We describe a new technique of excision and tension-free primary closure of pilonidal sinus disease, combined with application of fibrin glue in order to obliterate the dead space and to promote wound healing.

METHODS

A curved incision of the carried out, 2-3 cm lateral to the opening of the sinus, done under general or spinal anesthesia, and a thick flap was created by undercutting the medial edge and advancing it across the midline. The sinus was completely excised with all of its extensions. The flap was then sutured back to its original place by several interrupted monofilament mattress sutures. Then, 2-4 ml of fibrin glue was injected through the original pilonidal sinus opening to the sinus bed in order to obliterate the dead space.

RESULTS

Thirty patients with pilonidal sinus disease were treated by this technique. In four patients, there was a temporary purulent discharge through the opening of the sinus, and there were no other complications. The mean period for returning to daily activities and to work for patients was 11 days (SD=6 days). No infection or recurrent disease was noticed during the follow-up period (23+/-3 months).

CONCLUSIONS

Complete excision with tension free closure with fibrin glue application may be a useful technique for the treatment of pilonidal sinus disease.

Detection of cancer cells in the axillary drainage using RT-PCR after operations for breast cancer

The object of this study was to examine whether MUC-1 can be detected in the axillary lymphatic drainage of patients who have undergone conservative surgery for breast cancer and to assess the correlations between the presence of MUC-1 and prognostic factors in breast cancer. Sixty-eight women with invasive ductal carcinoma of the breast underwent wide local excision and axillary lymph node dissection. Axillary drains were inserted in all these cases, and the presence of MUC-1 and beta-actin was evaluated by RT-PCR in the lymphatic fluid collected after the operation. Prognostic factors included tumour size and grade, vascular and lymphatic invasion, clearance margins of the resected specimens and status of the axillary lymph nodes. RT-PCR assays for MUC-1 in the axillary fluid were positive in 17 patients (25%). The presence of MUC-1 was associated with increased tumour size and showed a positive correlation with axillary lymph node metastases and incomplete resection of the tumour. RT-PCR can disclose cancer cells in the axillary fluid after conservative surgery for breast cancer. The presence of MUC-1 in the axillary drainage may be associated with poor prognostic features, and its detection may have implications for therapy as it suggests that re-excision should be considered.

Aortic Dissections: New Perspectives and Treatment Paradigms

Aortic dissection is a complex manifestation of disease of the arterial wall. The severity and consequences of a dissection are related to the physical characteristics and anatomic location of the tear as well as the underlying patient physiology. Despite in vitro and in vivo modeling advances, our understanding of the pathophysiology has been limited to evaluations of the success and failure of various treatment modalities. The indications for intervention have historically included rupture, intractable pain or hypertension, distal ischemia and degeneration of the aortic wall causing aneurysm formation. The management decisions for patients with dissections are dependent upon the abnormal anatomy, the acuity of the patient presentation, and physiology. Despite the availability of open surgery as a therapeutic option, acute dissections with evidence of ischemia are now handled using an endovascular approach that is specifically directed at the cause of the ischemia. Endovascular treatments include the placement of a stentgraft into the proximal aorta, branch vessel stenting, uncovered stent placement in the abdominal aorta, and aortic fenestrations. Chronic dissections, in contrast, are still most frequently managed with open surgical techniques. However, a subset of patients that are not candidates for traditional surgical repair of the thoracoabdominal aorta may be managed with a combined open mesenteric revascularization with subsequent endovascular grafting of the thoracoabdominal aorta.

Feasibility and safety of percutaneous endoscopic gastrostomy in patients with subtotal gastrectomy

BACKGROUND AND STUDY AIMS

We aimed to study the technical feasibility, safety, efficacy and complications of endoscopic feeding tube placement in patients who had previously undergone subtotal gastrectomy. We also investigated whether jejunal feeding tube placement (percutaneous endoscopic jejunostomy [PEJ]) is superior to gastric feeding tube placement (percutaneous endoscopic gastrostomy [PEG]) in the prevention of aspiration pneumonia in patients with subtotal gastrectomy.

PATIENTS AND METHODS

A retrospective cohort study was carried out which included 48 patients treated between 1995 and 2001. Participants were selected from 3400 patients who were referred for PEG placement. The study group consisted of 15 consecutive patients with a prior subtotal gastrectomy. The control group comprised 33 randomly selected patients with intact stomachs. The primary end point of the study concerned the safety of PEG placement. The secondary end points included the efficacy and technical difficulty of the procedure.

RESULTS

PEG/PEJ placement was successful in 14 of the 15 patients (93 %) who had previously had a subtotal gastrectomy. None of the study patients developed procedure-related complications. Feeding intolerance was more common in patients with gastrectomy compared with patients with an intact stomach, but the difference did not reach statistical significance (10 % vs. 3 %, P>0.05). A significantly higher incidence of pneumonia was observed in patients with gastrectomy compared with patients with an intact stomach (P=0.01). Subgroup analysis showed that the risk was higher with jejunal tube placement compared with gastric tube placement (42 % vs. 12 %, P=0.001).

CONCLUSION

PEG/PEJ placement in patients with gastrectomy is a technically safe procedure. These patients are at higher risk of aspiration pneumonia and risk is higher with jejunal tube placement compared with gastric tube placement.

Copper and zinc blood levels among children with nonorganic failure to thrive

BACKGROUND AND AIMS

Copper and zinc deficiency are commonly reported among children with organic failure to thrive. In contrast, reports on copper and zinc status in children with non-organic failure to thrive are scarce. The goal of this study was to evaluate copper and zinc blood levels and nutritional intake among children with non-organic failure to thrive.

METHODS

A study group of 32 children with non-organic failure to thrive were investigated and compared with 32 healthy controls. Each child had copper and zinc blood level measurements. In addition, the study group underwent evaluation of thyroid function, immunoglobulins, endomesial antibodies and xylose test. A dietary questionnaire that included a diet history and a 24-h dietary recall was administered to parents by a dietician. Weight for height, height for age and mean daily intake of calories, protein, copper and zinc were calculated.

RESULTS

There were no significant differences between the two groups in either socioeconomic status or caloric, copper or zinc intake. Protein intake was significantly lower in the study group (P<0.0001). Plasma copper levels were within the normal range in both groups (P=0.3). Zinc plasma levels were significantly higher in the study group as compared to controls (P=0.03); however, they remained within the normal range in both groups.

CONCLUSIONS

Children with non-organic failure to thrive can maintain plasma copper and zinc levels within normal range and similar to normal controls.

Portal vein air embolization after blunt abdominal trauma: a case report and review of the literature

Gas in the portal vein is a rare and often fatal condition in surgical patients. However, the presence of gas in the mesenteric and portal veins in association with abdominal trauma is a transient incidental finding that resolves spontaneously. We describe a young patient with Crohn's disease who suffered air embolism of the portal veins secondary to blunt abdominal trauma. The condition was clinically benign and resolved spontaneously. The pathogenesis is discussed and a review of the literature is provided.