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We report the manometric findings in a case of dilated small bowel and disturbed transit successfully treated with plication of the dilated small bowel. The female newborn infant required total parenteral nutrition following an operation for small bowel atresia. X-ray showed a dilated proximal small bowel. Jejunal manometry showed normal phase 3 migration but persistently low-amplitude contractions in the dilated segment. After plication of the dilated intestine, symptoms of bowel obstruction disappeared. A second manometry two weeks after the operation showed contractions with normal amplitude. These findings indicate that: (1) disturbed transit in the dilated intestine proximal to small intestinal atresia is associated with persistently low contraction amplitude, and (2) the amplitude can be increased by the plication of the dilated loop.

Le lait maternel stocke provoque la cytolyse des hematies et des leucocytes du sang humain peripherique ainsi que des cellules de Raji et Molt4, alors que le lait frais ou le lait de vache n'ont pas cet effet. Nous avons etudie les conditions de stockage (1) dans lesquelles cette cytolytique apparait et (2) la substance responsable de la cytolyse. Sur chaque echantillon, nous avons determine la cytolyse des leucocytes et des cellules de Raji et Molt4 par examen au microscope des cellules incubees pendant 48 h a 37 °C. L'hemolyse a ete determinee par mesure de la densite optique du surnageant de centrifugation apres incubation de tous les echantillons d'hematies pendant 30 min a 37 °C. L'activite cytolytique du lait maternel varie en fonction de la duree et de la temperature de stockage. L'activite cytolytique est presente apres 3 h de stockage a 20 °C, apres 6 h a 4 °C et apres 12 h a -20 °C. Lorsqu'il a separation par centrifugation apres stockage de 24 h a 4 °C, la cytolyse est induite par la creme et non par le petit-lait. Lorsqu'il y a separation et que la temperature est portee a 56 °C pendant 30 min avant stockage, il n'y a aucune activite cytolytique de la creme et du petit-lait. Lorsque la creme est chauffee a 56 °C pendant 30 min et melangee au petit-lait non traite avant stockage de 24 h a 4 °C, il y a action cytolytique. L'action cytolytique est avivee par adjonction de sel biliaire au lait avant stockage. Au contraire, lorsque l'on ajoute de l'eserine, l'activite cytolytique est supprimee. La chromatographie en couche mince montre qu'a la difference du lait frais, le lait stocke contient des acides gras libres qui provoquent une cytolyse de meme intensite que dans la lait complet stocke. Nous en concluons 1) que le lait humain stocke a une action cytolytique sur les globules du sang humain, 2) que l'activite cytolytique apparait selon une courbe en relation avec le temps et la temperature et 3) que la cytolyse est due au acides gras libres qui sont synthetises sur les triglycerides catalysees par la lipase dans le lait.

Maximal tension generated by gastric muscle is three to four times greater in weanlings than in newborn rabbits. To determine if this functional maturation is accompanied by structural changes, we compared length-tension relationships, myocyte number and size, and actomyosin content in muscle from the gastric body of newborn (1 day) and weanling (12 weeks) rabbits. Passive tension at optimal length (Lo) was six times greater in circular smooth muscle strips from weanling rabbits than from newborn rabbits. Active tension at Lo in weanling rabbits was three times greater than in newborn rabbits. For morphometry, muscle cross-sections stretched to Lo in the circular axis were photographed with electron microscopy (5300x). Cell number/unit area was counted in circular muscle layers from newborns and weanlings. Cross-sectional area of each cell was measured by computerized planimetry. There were 2.5 times more cells per unit area in newborn than in weanling tissue, P < 0.001. However, the mean cell area in newborns (5.4 +/- 4.6 microns2) was less than that in weanlings (13.5 +/- 11.7 microns2). Consequently, the muscle cells occupied similar total areas in newborns and weanlings. We measured actin and myosin heavy chain in full-thickness muscle homogenates using SDS gel electrophoresis and densitometric scanning. Actin and myosin concentrations were lower in newborns (9.6 +/- 1.3 micrograms g-1 wet weight and 5.6 +/- 0.7 micrograms g-1 wet wt, respectively) than in weanlings (17.7 +/- 3.0 micrograms g-1 wet wt and 8.2 +/- 1.6 micrograms g-1 wet wt respectively), each P < 0.01. The proportion of myosin heavy chain isozymes did not change with age. We conclude that there are postnatal increases in cell size and the quantity of actin and myosin in rabbit gastric muscle. The increase in quantity of contractile protein may be in part responsible for age-dependent increases in maximal tension.

To evaluate the effects of erythromycin on antroduodenal motility in children with chronic functional gastrointestinal symptoms, we studied 35 consecutive subjects referred for diagnostic motility studies. We recorded fasting motility for > 4 hr, then infused in random order either 1 or 3 mg/kg erythromycin intravenously over 1 hr and continued the study for another hour. Erythromycin induced phase III in 18 of 20 children who had phase III during fasting compared to only one of 15 who did not (P < 0.001). The antral motility index increased after erythromycin (1596 +/- 323 vs 436 +/- 242 mm Hg/30 min before erythromycin, P < 0.005) but the duodenal motility index did not change. The antral motility index was greater in children receiving 3 mg/kg than in those receiving 1 mg/kg (1968 +/- 391 vs 1226 +/- 285 mm Hg/30 min, P < 0.01), but duodenal motility indices did not differ. Only one child receiving the lower dose erythromycin complained of abdominal pain, nausea, or vomiting vs 9 of 19 the children receiving the higher dose (P < 0.02). In summary, in children with chronic functional gastrointestinal disorders, erythromycin rarely induced phase III in patients who did not have it during fasting. When different doses erythromycin are compared, 1 and 3 mg/kg are equally efficacious in inducing phase III episodes; the lower dose is associated with fewer side effects and the higher dose produces a higher antral motility index.

Hypervitaminosis D is one of the causes of severe hypercalcemia in children. Most cases of hypervitaminosis D during childhood are due to an excessive supplementation of vitamin D by physicians or parents.1,2 To prevent metabolic bone disease of prematurity (rickets of prematurity), formulas designed for premature infants ("premature formulas"), which contain more calcium and vitamin D than standard formulas, are given to premature infants in addition to human milk.1 In some cases, separate vitamin D products are also given to these infants, although requirements for vitamin D and calcium intake in the premature infant and the formerly premature infant have not been fully estimated.1

The aims of this study were to identify mediators of relaxation in rabbit proximal gastric circular smooth muscle and to assess age-dependent changes in tissue response. Vasoactive intestinal peptide (VIP), adenosine, and norepinephrine induced tetrodotoxin-insensitive, concentration-dependent relaxation in bethanechol-precontracted (3 µM) gastric muscle strips from newborns and weanlings. Maximally effective concentrations of 10 µM VIP induced complete relaxation in newborns, but only 30% relaxation in weanlings (p < 0.01). Maximally effective concentrations of adenosine induced complete relaxation at both ages. Adenosine (ED50 3 µM) was more potent than adenosine triphosphate, indicating the presence of P1 purinergic receptors. In newborns norepinephrine induced complete relaxation (ED50 0.5 µM). The response to norepinephrine changed in age-dependent increments from relaxation in newborns to strong contraction in weanlings. In weanlings phentolamine inhibited norepinephrine-stimulated contraction, revealing persistent propranolol-sensitive relaxation. Tetrodotoxin and atropine had no effect on norepinephrine-stimulated contraction. In summary, in rabbit gastric circular smooth muscle: (1) VIP, adenosine, and norepinephrine induce relaxation; (2) VIP loses efficacy with age; (3) there is a β-adrenergic receptor mediating relaxation in the newborn which persists, and (4) an α-adrenergic receptor mediating contraction emerges early in postnatal life. Age-dependent changes in response to VIP and norepinephrine may contribute to the postnatal maturation of the gastric motility.

Interobserver variability affects investiga- tions involving assessment of complex visual data, such as histopathology, radiology and motility. This study assessed interobserver variation for interpreta- tion of antroduodenal manometry (ADM), as this has not been previously investigated. Thirty-five ADM recordings from children aged 0.3-18 years were independently evaluated by five experienced paediat- ric gastroenterologists who were blinded to cases clinical histories. Intra-class correlation (ICC) was analysed for detection and measurement of phase three of the migrating motor complex (MMC) and Cohens kappa statistic was calculated between observer pairs for detection of specific motility features and final diagnosis. Observers were unanimous on the differentiation of normal and abnormal motility in 63% of cases. There was excellent interobserver agreement for the number of phase three of the MMC in fasting (ICC = 0.82, P < 0.0001) and for measure- ments of phase three of the MMC (ICC = 0.9999, P < 0.0001). Detection of other normal and abnormal motility patterns varied more. Objective findings such as the presence of phase three of the MMC correlated more closely than findings that involved the integra- tion of several variables, such as final diagnosis. However, these data overall indicate that agreement between expert observers for the distinction of normal and abnormal antroduodenal motility compares favourably with other standard medical assessments.

To investigate the role of corticosteroids in the initial treatment of Kawasaki disease (KD).Between September 2000 and March 2005, we randomly assigned 178 KD patients from 12 hospitals to either an intravenous immunoglobulin (IVIG) group (n = 88; 1 g/kg for 2 consecutive days) or an IVIG plus corticosteroid (IVIG+PSL) group (n = 90). The primary endpoint was coronary artery abnormality (CAA) before a 1-month echocardiographic assessment. Secondary endpoints included duration of fever, time to normalization of serum C-reactive protein (CRP), and initial treatment failure requiring additional therapy. Analyses were based on intention to treat.Baseline characteristics of groups were similar. Fewer IVIG+PSL patients than IVIG patients had a CAA before 1 month (2.2% vs 11.4%; P = .017). The duration of fever was shorter (P.001) and CRP decreased more rapidly in the IVIG+PSL group than in the IVIG group (P = .001). Moreover, initial treatment failure was less frequent (5.6% vs 18.2%; P = .010) in the IVIG+PSL group. All patients assigned to the IVIG+PSL group completed treatment without major side effects.A combination of corticosteroids and IVIG improved clinical course and coronary artery outcome without causing untoward effects in children with acute KD.

A girl born after 36 weeks' gestation had emesis 15 hours after birth. She required total parenteral nutrition (TPN) because of persistent gastric retention. When milk was given, the volume of gastric aspirate 3 hours after feeding often was greater than the volume given. Domperidon and erythromycin were ineffective. Upper gastrointestinal series showed slow gastric emptying but no abnormalities in the stomach. No stenosis or obstruction below pylorus was found. Endoscopy showed normal gastric mucosa. Manometry showed normal antroduodenal motility patterns. Transpyloric feeding, which started at age 73 days, was successful and enabled cessation of the TPN. Laparotomy at 119 days of age showed partial absence of the muscle and serosal layer in the anterior wall of the gastric body (1 x 4 cm). The mucosal layer was intact and partly adhered to the peritoneum and the left lobe of the liver. The defect was surgically corrected by plicating the place. The postoperative course was excellent, and oral feeding was fully established within 2 weeks. Although the cause of the partial muscle defect in the case is unclear, this case suggests that this rare condition can cause severe chronic gastric retention.

We investigated the possible involvement of the upper alimentary tract in vincristine (VCR)- induced dysmotility. Gastric contractions were recorded by a strain-gauge force transducer in conscious rats. Rats were injected with various doses of VCR followed by continuous recording for 12 hr. Additionally, 3-hr recordings to study the later effects were performed one and three days after injection. Gastric motility was dose-dependently increased by VCR. Post- versus preinjection motility index (MI; area under contraction waves) ratios were 0.78 ± 0.12 for saline and 1.95 ± 0.21 for VCR at 0.75 mg/kg. This increase in MI was completely inhibited by atropine and hexamethonium. MI one day after injection of VCR (0.75 mg/kg) was significantly less than in control (0.32 ± 0.10 vs 0.92 ± 0.24, respectively). The decrease was reversed by acetylcholine. In conclusion, VCR first increased gastric motility, and this was followed by a gradual decrease in conscious rats. These alterations may involve a presynaptic cholinergic pathway.

Background: WslWs rat (Ws) has a mutation at the c-kit gene which has a critical role in the development of interstitial cells of Cajal (ICC). In the gastrointestinal tract of Ws ICCs are either absent or markedly reduced. In vitro studies using intestinal muscle strips showed that regularity of contractions is severely impaired in Ws. Interestingly, however, Ws rats can live and be fertile, while the WlWv mouse with a mutation at the c-kit gene can not survive. In the present study we recorded gastrointestinal mechanical contractions in vivo in Ws and control (wild type: (+1+» rats. Methods: Ws (8weeks old, approximately 250g, n=9) and control rats (Cont, n=8) were operated under nembuthal anesthesia. Miniature strain gauge force transducers developed specifically for in vivo rat motility studieswere sutured onto the serosal side of the gastric antrum and jejunum (5cmto 8cm distal to pylorus). In order to confirm the migration of intestinal phase 3s, two transducers were attached in proximal jejunum 5 em apart in Ws (n=2) and Cont (n=3). After 4 to 7 days recovery period and 24-36 h fasting, lead wires of transducers were connected to transducers and contractions were recorded in computer through an amplifier and an AID converter. Rats were free of any body restrictions. Results: (I) In Ws sporadic or short c1usters( 1 min) clusters of rhythmic contractions were the dominant pattern in Cont. Migration of those gastric clusters to the duodenum were not clearly observed. (2) In the duodenum and jejunum, MMC patterns were present in 4 out of II Ws and in 6 out of II Cont. The mean duration, interval, and frequency of contractions of phase 3 were 2.3+/-0.6 min, 28.7+1-8.7 min, 29.5+1-2.0 min'! and 4.5+1-0.9 min, 12.3+1-1.6 min, 34.3+1-2.2 min'! in Ws and Cont, respectively. (3) In phase 2 of small intestine, clusters of contractions with various length were the dominant contraction pattern in borh Ws and Cont. (4) Feeding immediately changes motility patterns both in Ws and in Cont. Conclusion: Unlike normal rats, clusters of rhythmic contractions are rare in the stomach of Ws. Although phase 3-like clustered contractions were present in the small intestine in Ws, they are quantitatively different from those in Cont.

Background: Developmental changes occur in the gastric mucosal defense mechanism. Experimental mucosal injuries produced by intragastric ethanol or HCl are greatest in newborn rats and decreased with age. Recovery of the mucosa from injury was faster in newborn rats than in older rats. In the present study, to determine if metabolism of prostaglandins is responsible for the physiological characteristics of the mucosal protective mechanisms in developing rats, we studied COX mRNA expression in rats of various age with/without acute mucosal injury by quantitative (kinetic) RT-PCR. The effect of age on endotoxin-induced mRNA expression was also investigated. Methods: Gastric mucosa was excised from male Wistar rats and separated from the muscle layer. mRNA was extracted and converted to cDNA using random primers. The number of copies of cDNA for COX I, COX2, and GAPDH(internal control) was measured using real-time PCR with Taqmann Probes. Mucosal injuries were produced by administrating 0.005 ml/kg of l50mM HCI-60% EtOH through nasogastric tube 60 min prior to the sacrifice. Results:COXl mRNA expression was lowest in l -week-old rats, and highest in 4-week-old rats. Mucosal injury did not increase COXI mRNA expression in any age group. Expression of COX2 mRNA was highest in l-week-old rats and then decreased with age. Mucosal injury increased COX2 mRNA in each age group, mostly in one week old rats (Table). There were no age-related changes in COX2 mRNA expression in response to lipopolysaccharide O,5,lOmg/kg,ip). Conclusion: The high level of COX2 mRNA expression in the gastric mucosa of l-week-old rats might be responsible for the physiological charateristics of gastric mucosal defense in this age group.

Background. Although recent advances in computer technology enable us to analyze gastrointestinal sounds data objectively with ease, this clinical application has been investigated in only a few disorders. To investigate one potential role of this approach in pediatric practice, we recorded and analyzed gastrointestinal sounds in infants with hypertrophic pyloric stenosis (HPS), a motility-related disorder that is common in children. Methods. In 15 infants with pyloric stenosis, gastrointestinal sounds were collected with a microphone placed 3 cm below the umbilicus for 60 minutes before pyloromyotomy and at 9 to 12 hours, 20 to 24 hours, 40 to 48 hours, and 112 to 120 hours after the operation. Data were entered into a computer to sum the amplitude of sound signals as a sound index (SI; mV per minute). In 12 infants, gastric emptying was measured immediately before each sound recording, using a marker dilution-double sampling method. Results. Before surgery, the mean SI was 4.6 ± 1.0 mV per minute, significantly less than in healthy controls (31.7 ± 8.4 mV per minute). The SI remained in a similar range until 12 hours after operation, after which it began increasing to reach the normal range by 48 hours after operation (30.0 ± 9.4 mV per minute). Gastric emptying, also low in HPS before pyloromyotomy, increased by 4 to 5 times after surgery. There was a significant positive correlation between SI and gastric emptying. The incidence of postoperative symptoms (such as vomiting) were correlated significantly with SI at 24 hours after surgery. Conclusion. This study found decreased gastrointestinal sounds to be among physical findings suggestive of HPS and a useful indicator of gastric emptying and bowel motility after pyloromyotomy. Computer-assisted analysis of gastrointestinal sounds might be helpful in clinical practice for pediatric patients with some gastrointestinal disorders.

A 14-month-old severely retarded girl with a history of regurgitation, aspiration, and recurrent pneumonia was found to suffer from diffuse oesophageal spasm. This diagnosis was made by oesophageal cine-radiography. This case suggests that diffuse oesophageal spasm is an oesophageal motility disorder that causes respiratory disease in the retarded child.

It is not well known which symptoms or signs related to peptic ulcer are crucial for its diagnosis in children. In order to clarify this problem, we evaluated the sensitivity, specificity, and positive and negative predictability of 13 ulcer-related symptoms and signs. The data of 160 patients, who were suspected of having peptic ulcer and had undergone endoscopic examinations, were studied. It was significant that five symptoms, i.e., presence of pain in the epigastrium, relationship between the time of pain and that of eating, family history, vomiting, and bleeding, were frequently found in ulcer patients. There was, however, no symptom or sign that predicted by itself precisely the existence of a peptic ulcer. Thus, we computed a discriminant function by combining the data by multivariate analysis. With this score, we could predict the existence of ulcer more precisely. Finally, it was concluded that epigastric pain, food-related pain, vomiting, bleeding, and family history were crucial factors for the diagnosis of peptic ulcer in childhood and that an overall consideration of symptoms and signs was needed for the evaluation of these factors.

A 4-year-old girl with virus-associated haemophagocytic syndrome is described, suffering from fever, jaundice, rectal bleeding and a loss of consciousness. Severe pancytopenia was a prominent finding. The bone marrow biopsy showed hypocellularity, and bone marrow aspiration revealed proliferation of histiocytes containing many erythrocytes and thrombocytes. The patient recovered within several weeks of supportive therapy. Viral studies demonstrated a recent infection with Epstein-Barr virus.

We report on the intestinal motility in a case of megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) based on a total registered time of 9.5 h by means of a manometric method we recently developed for neonates. The characteristics of this case are as follows: (a) the frequency of the contractions in the stomach and duodenum was significantly lower than that of healthy infants; and (b) bands of rhythmic contractions, resembling phase III activity of the interdigestive migrating contractions in adults, were recorded in the duodenum, but their occurrence was less frequent and the amplitude was significantly lower than that of healthy infants. The present study indicates that "hypoperistalsis" in MMIHS means not only the low frequency, but also the low amplitude, of the contractions in the alimentary tract.

Fifteen healthy subjects, fasted at least 8 hr, were studied by means of an infused manometric method. Twenty minutes after termination of the natural phase III activity in the duodenum, erythromycin or normal saline was administered intravenously for 15 min. When normal saline (N = 5) was infused, the next migrating motor complex (MMC) was initiated 151.2 +/- 42.1 min after the infusion. On the other hand, when erythromycin was infused at a rate of 1.0 mg/kg/hr (N = 5) or 3.0 mg/kg/hr (N = 5), MMC-like contractions were initiated at shorter intervals, ie, 47.8 +/- 40.9 min (P less than 0.005) or 23.0 +/- 13.0 min (P less than 0.001) respectively. The duration, frequency, amplitude, and migrating velocity of the naturally occurring MMC (N-MMC) were not significantly different from those of the erythromycin-induced contractions except for the duration of the phase III contractions in the stomach; the duration (5.3 +/- 2.2 min) of the erythromycin-induced contractions being significantly (P less than 0.05) longer than that (3.2 +/- 0.9 min) of the naturally occurring MMC. The immunoreactive motilin (IRM) concentration did not increase significantly after the infusion of erythromycin, when compared to that after infusion of normal saline. It is concluded that erythromycin at a dose of 1-3 mg/kg/hr for 15 min during the interdigestive state, similar to motilin, has a significant influence upon the initiation of MMC in the human gastrointestinal tract, but further investigations are required to confirm whether endogenous motilin is involved or not.

We studied gastrointestinal motility in 20 infants, using a modified manometric method for neonates, and compared it to that in adults. Changes in the intragastric and intraduodenal pressures were recorded for 3 h after the ingestion of milk. Bands of contractions with the same rhythmicity as phase III activity in adults were frequently recorded. Some of them migrated caudally and were speculated to be the equivalent of phase III activity of the interdigestive migrating complex (IMC) in adults. However, others did not migrate and showed some differences from phase III activity of adults and infants in the time of occurrence, duration and amplitude. The characteristic of gastroduodenal motility in infants was the frequent occurrence of these bands of nonmigrating rhythmic concentrations. Our findings indicated the following problems: (1) there are some differences in gastrointestinal motility between infants and adults and further investigations are required for the evaluation of the physiology or pathophysiology of this phenomenon; (2) in infants, many bands of rhythmic contractions of the alimentary tracts can exist without migration. This indicates the possibility that the occurrence of rhythmic contractions and their migration are regulated by different mechanisms.