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Aluminum loading in children with chronic renal failure. Kidney Int 1984;26:201. 9. Griswold WR, Reznik V, Mendoza SA, Trauner D, Alfrey AC. Accumulation of aluminum in a nondialyzed uremic child receiving aluminum hydroxide. Pediatrics 1983;71:56. 10. Slanina P, Frech W, Ekstrom LG, Loof L, Slorach S, Cedergren A. Dietary citric acid enhances absorption of aluminum in antacids. Clin Chem 1986;32:539. l l. Trompeter RS, Polinsky MS, Andreoli SP, Fennell RS. Neurologic complications of renal failure. Am J Kidney Dis 1986;4:318-23. 12. Roodhooft AM, van de Vyver FL, Haese CD, van Acker K J, Visser W J, de Broe ME. Aluminum accumulation in children on chronic dialysis: predictive value of serum aluminum levels and desferrioxamine infusion test. Clin Nephrol 1987;28: 125-9. 13. McCarthy JT, Milliner DS, Kurtz SB, Johnson W J, Moyer TP. Interpretation of serum aluminum values in dialysis patients. Am J Clin Pathol 1986;86:629-36. 14. Bene C, Manzler A, Bene D, Kranias G. Irreversible ocular toxicity from single "challenge" dose of deferoxamine. Clin Nephrol 1989;31:45-8. 15. Lawson M, Milla P J, Harper JI. Aluminum and infant formulae. Lancet 1989;1:614. 16. BirchalI JD, Chappell JS. Aluminum, chemical physiology, and Alzheimer's disease. Lancet 1988;2:1008.

Background The aims of this study were to understand the lived experience and elements of quality of life as depicted by children and adolescents with inflammatory bowel disease (IBD). Methods Eighty participants with IBD, ranging in age from 7 to 19 years, were interviewed about the impact of IBD on their daily lives. Results Findings demonstrated that IBD profoundly affects children and adolescents. These young patients experience concerns and discomfort as a result of IBD symptoms and treatments. They commonly feel, in varying degrees, a sense of vulnerability and diminished control over their lives and future, and perceive themselves as "different" from healthy peers and siblings. Despite these negative impacts, participants also described effective means of coping with IBD, and reported that support from family members and friends contributes to coping. A positive attitude and other strategies were also described as strengths contributing to quality of life. Conclusion Clinical assessments need to consider the experiences and perceptions of children as they manage their IBD. Implications for clinical practice are discussed.

respectively (p=NS). The probabdity of moderately acnve disease did not demonstrate significant dilfi:mnce with NSA1D use, though CD patients on high-dose NSA1Ds had a 1,27dbld increase likelihood of moderately active disease as compared with patients on noNSAIDs. Subgroup analysis showed die increase in disease activity among CD patients taking high-dose NSAIDs was limited to patients with colonic niw~lvement. For CD patients with limited ileal involvement the MHB scorn was 4.01 with no-NSAIDs and 3.85 on high-dose NSAIDs. CD patients with ileocolonic or isolated colonic disease had an MHB score of 4.11 with noNSAIDs but increased to 5 47 with high-dose NSAIDs (p = 0.008). Among the UC patients, there was a trend towards a higher disease activity score among patients with pancofitiS(as opposed to distal disease). The LS increa~d from 5.79 to 7.43 comparing the pancofitis no-NSAIDs vs. high-dose NSAIDs (p = 0.21). Condusions: Use of low-dose NS?dDs was not a ~ i a t e d with an increase in disease activity for these outpatients witfi either CD or UC, Use of high-dose NSA1Ds was associated with a higher level of disease activity among CD patients with colonic involvement.

Vibrationally resolved resonance fluorescence has been recorded from nitrogen dioxide after excitation in the region 445–460 nm. Emission to v3 = 1 vibrational levels of the ground electronic state is observed in all our spectra.

Ten cases of gastroduodenal inflammation were diagnosed by endoscopy among a series of 196 children with evidence of Crohn's disease involving other regions of the intestinal tract. Endoscopic and histologic confirmation of upper gastrointestinal tract involvement was performed only in those cases with suggestive symptoms. The mean age at presentation in the 10 cases with gastroduodenal inflammation was 14.6 +/- 1.9 (+/- SD) years, with involvement identified at the time of initial diagnosis of Crohn's disease in five of the 10. Eight of 10 cases occurred in boys. The major presenting symptoms were weight loss in five cases, epigastric pain in three, and recurrent vomiting in two. Hematemesis and melena occurred in only one of the 10 cases. Endoscopic and histological evidence of mucosal inflammation was seen in all 10 cases. Three of 10 cases had noncaseating granuloma present in biopsies of the stomach or duodenum. Two cases also had endoscopic and histological evidence of esophageal involvement. All cases were initially treated with oral corticosteroids, and in each instance a good clinical response was noted. Sucralfate (n = 1), 6-mercaptopurine (n = 1), and H2 receptor antagonists (n = 3) were used as adjunct therapy. After follow-up for 2.7 years (range, 0.5-5.5 years), none of the 10 cases required surgical intervention. Therefore, at least in the short-term, the outlook for adolescents with gastroduodenal Crohn's disease appears to be good and their medical management need not differ from those patients with Crohn's disease involving only more distal portions of the small intestine.

Expansion of tetracene vapour with excess argon carrier gas through a nozzle of a supersonic jet apparatus permits the controlled formation of (C 18 H 12 )Ar n molecules. These have been studied by laser fluorescence techniques in the 450 nm region of the spectrum corresponding to excitation of the parent tetracene molecules to the 1 B 1u electronic state. We have been able to observe up to the n = 10 complex and have identified three different binding sites on the tetracene framework. From the resolved fluorescence spectra of these species one obtains an upper limit of the van der Waals binding energy of 314 cm −1 in the upper electronic states and 274 cm −1 in the ground state. These resolved spectra also exhibit features identified as due to the tetracene-argon stretching vibration giving a value of 36.5 ± 2 cm −1 for the lowest transition in the ground state of (C 18 H 12 )Ar.

A simple relationship is shown to occur between spectral line position and the number of bound argon atoms in the electronic spectrum of argon-tetracene van der Waals molecules, in contrast to the conclusion of other workers. We show that bonding information may be obtained from such spectra.

Energy, nitrogen absorption, and nitrogen utilization of two commercial elemental diets, Vivonex and Vital, were compared in 10 teenage boys and girls with Crohn's disease. The diets were given in random order as overnight feedings and were the sole source of nutrients for two consecutive periods of 3 weeks each. Urine and stools were collected for 48 h at the end of each 3-week period. Energy absorption was slightly better on Vivonex (p less than 0.05), although 95-100% of energy was absorbed with both formulas. Nitrogen absorption was not different for the two formulas, but nitrogen utilization was significantly better on Vital (28.6 +/- 12.9% versus 9.7 +/- 17.7%, p less than 0.01). This difference may be attributable to the different concentrations of sulfur-containing and aromatic amino acids in the two formulas.

What really happens to people on long-term peritoneal dialysis? Background. Several risk factors for patients treated with peri- toneal dialysis (PD) have now been identified. These include age, comorbid disease, nutritional status, loss of residual renal function (RRF) and high peritoneal solute transport. This is not the same, however, as knowing what actually happens to these patients, particularly in the long-term. The purpose of this review was to give as complete a description as is currently possible of the long-term PD patient. Methods. The literature was surveyed for publications that provide longitudinal cohort data of either selected or unselected patient groups. Detailed data from the Stoke PD Study is pre- sented in the context of these studies. Three principle aspects of what really happens to patients were considered: (1) death, both cause and mode of death; (2) technique failure, with reference to peritoneal function and how the cause of technique failure related to patient survival; and (3) evolution of clinically relevant param- eters of patients on PD, such as nutrition and peritoneal function. Results. Sudden death and debilitation were the predominant modes of death, with sepsis playing a contributory role. Debilita- tion was important regardless of co-existent comorbid disease, and time to death was not influenced by the mode of death. Predominant causes for technique failure remain peritonitis and ultrafiltration, the latter becoming more important with time on treatment. Technical failure is associated with poorer survival, particularly when due to multiple peritonitis or failure to cope with treatment. Cox regression demonstrated that whereas low albumin, loss of RRF and high solute transport predicted patient death, only high solute transport predicted technique failure. Longitudinal changes over the first five years of treatment in- cluded loss of RRF, increasing solute transport and following an initial improvement in nutritional state, a decline after two years. Patients surviving long-term PD (at least five years, N 5 25) were characterized by prolonged RRF, maintained nutrition and lower solute transport in the medium term. Conclusions. Several studies of long-term PD in the literature now complement each other in providing a picture of what really happens to PD patients. The links between loss of solute clear- ance and poor peritoneal ultrafiltration combining to exacerbate sudden or debilitated death and technique failure are emerging. For PD to be successful as a long-term therapy, strategies that maintain nutrition and preserve peritoneal membrane function must be developed. Despite the fact that continuous forms of peritoneal dialysis (PD) have been in use for 20 years and that it is a well established treatment in the medium-term (1-3), our detailed understanding of what actually happens to patients using this modality in the longer term is only now beginning to develop. The 1980s were spent addressing the more pressing problems of the technique, such as high peritonitis rates, while at the same time those factors that determine patient outcome as they relate to dialysis adequacy were beginning to be defined for the hemodialysis population (4). The 1990s have seen these concerns addressed within the PD population, and we now have a far clearer idea of those factors that predict good outcome in these patients (5-7). However, this is not the same thing as knowing what actually happens to these individuals, which is the focus of the present review. There are now several large cohort studies in the litera- ture that provide information about what actually happens to patients on PD in the medium to longer term, and these are summarized in Table 1 (2, 3, 8 -16). These studies vary in size, with the larger multicenter studies having the advantage of patient numbers that can address comparative survival (patient and technique) with hemodialysis (2, 3, 10, 13, 16), whereas the smaller or single center studies can provide greater detail on nutrition, solute kinetics and