A fibreoptic laryngoscope for paediatric anaesthesia. A study to evaluate the use of the 2.2 mm Olympus (LF-P) intubating fibrescope.

A technique for the use of the Olympus LF-P as an aid to tracheal intubation, via the oral route, in 40 anaesthetised, spontaneously breathing children is described. The technique was completely successful in 30 (75%) of the children. Complications occurred in the remaining ten (25%); two developed laryngospasm and in seven the fibrescope flipped out of the trachea during the initial passage of the tracheal tube over the fibrescope.

Coeliac disease in children of West Indian origin.

Coeliac disease is uncommon in populations of non-European origin. Two English born West Indian children with coeliac disease are presented. The diagnosis should be considered in children of West Indian origin with chronic diarrhoea.

Novel insights into human intestinal epithelial cell proliferation in health and disease using confocal microscopy.

Measurement of intestinal epithelial cell proliferation has provided important information concerning tissue responses in neoplasia, enteropathy, and adaptation. This study reexamined current concepts regarding intestinal proliferation by using a novel confocal microscopical technique to map mitotic figures accurately within the intact three dimensional framework of the crypts of Lieberkühn. The ability of confocal microscopy to simultaneously measure crypt morphology and internal detail, without disrupting spatial cell arrangements, has provided important new data.

Serum interleukin-2 receptor in infants and young children.

Soluble interleukin-2 receptor (IL-2R) concentrations were measured in 110 serum samples from 102 children undergoing routine small bowel biopsy for a wide range of gastrointestinal symptoms. Young children in the control group who had no gastrointestinal disease and a normal intestinal mucosa were found to have high concentrations of IL-2R. There was a significant inverse relationship between IL-2R concentration and age in the control group.

Fatty acid composition of plasma and red cell phospholipids of preterm babies fed on breast milk and formulae.

Unlabelled: Fatty acids of plasma and red cells of preterm babies, gestational age 28-33 weeks, weighing less than 2200 g were studied between birth and the expected date of delivery (EDD). Babies were fed either mothers' breast milk, or if they were unable, or chose not to breast-feed, randomly assigned to milk formula A or B. Milk B had 26% oleic acid, 0.

Post-operative morbidity following paediatric tonsillectomy; a comparison of bipolar diathermy dissection and blunt dissection.

In a prospective study of 76 children aged between 18 months and 13 years, 40 children underwent tonsillectomy using the traditional blunt dissection technique with bipolar diathermy to establish haemostasis while 36 children underwent tonsillectomy where bipolar diathermy alone was used to dissect out the tonsils. Blood loss was significantly reduced in the diathermy dissection group (10.5 ml +/- 2.

Vitamin A and related essential nutrients in cord blood: relationships with anthropometric measurements at birth.

Following the advice given by the Department of Health to women who are, or may become pregnant, not to eat liver and liver products because of the risk of vitamin A toxicity, the concentrations of vitamins A and E, and copper, magnesium and zinc in cord blood were investigated. The study was conducted in Hackney, an inner city area of London. Esters of vitamin A were not detected in any of the samples, indicating that there was no biochemical evidence of a risk of toxicity.

Food sensitive enteropathy: overview and update.

There are two types of food sensitive enteropathy; permanent and temporary. Celiac disease belongs to the former, the temporary food sensitive enteropathies of early childhood to the latter. A food sensitive enteropathy is characterized by an abnormal small intestinal mucosa while having the offending food in the diet; the abnormality is reversed by an elimination diet, only to recur once more on challenge with the relevant food.

Chemical and glass thermometers for axillary temperatures: how do they compare?

Axillary temperatures recorded with a disposable chemical thermometer (DCT) measured a mean 0.29 degrees C higher than a mercury in glass thermometer (MGT) but differences could be wide. Differences between the same methods were however also wide.

Relationship of endocrinopathy to iron chelation status in young patients with thalassaemia major.

Disturbances of growth and development in patients with thalassaemia receiving hypertransfusion programmes are well recognised and are most likely to be due to iron overload. The extent of endocrine dysfunction was investigated in a group of 18 patients thought to have been treated by acceptable modern standards, 11 of whom could be considered as well chelated. Assessment of growth and puberty showed a wide variation in height SD scores with five patients having significantly short stature.

Nutritional status of schoolchildren in an inner city area.

Data were collected on the seven day weighed food intakes of 65 schoolchildren, aged 12-13 years, living in an inner city, socially deprived area in east London. Blood samples were collected during the week and analysed for cholesterol, serum ferritin, vitamins A, E, B-12, beta carotene, and folic acid. Boys generally fared better than girls with almost a quarter of the girls having intakes of calcium, magnesium, iron, zinc, vitamin A, and riboflavin less than the lower reference nutrient intake, an amount which, by definition, is enough for only the few people in a group who have low needs.

Endomysial antibody screening in children.

It has been suggested that endomysial antibodies are specific markers for coeliac disease. In a 13-month study, we examined the usefulness of screening for these antibodies in the diagnosis of coeliac disease in children. Twenty-one of 223 (9.

Intractable diarrhoea in infancy: a continuing challenge for the paediatric gastroenterologist.

Intractable diarrhoea of infancy is a syndrome of severe chronic diarrhoea, associated with malnutrition, which is not easily resolved by conventional management. Application of small bowel biopsy and colonoscopy with biopsy to children with this syndrome has identified specific entities, such as autoimmune enteropathy and microvillus atrophy. There remains a group of children with unexplained small intestinal enteropathy and idiopathic enterocolitis who pose a considerable problem for diagnosis and management.

Extensive naevus comedonicus in a child with Alagille syndrome.

Naevus comedonicus is a rare condition, thought to be a hamartoma in which cells of the pilosebaceous unit fail to develop appropriately. Although it is usually an isolated phenomenon, it has been associated with other defects, including those of the skeletal, ocular and central nervous system. A girl with this condition is described who also had Alagille syndrome (arteriohepatic dysplasia), a previously unreported association.

Medical management of chronic inflammatory bowel disease.

In the absence of a definitive cure for Crohn's disease and ulcerative colitis, the aim of therapy must be to induce and maintain clinical remission at acceptable cost to the patient in terms of adverse effects. Despite the differences in their pathogenesis, the first-line treatments for Crohn's disease and ulcerative colitis are still based upon combinations of amino-salicylic acid derivatives and corticosteroids, although the use of enteral nutrition regimes is becoming increasingly widespread in Crohn's disease. In this chapter we attempt to provide reasonably didactic guidance for the management of most cases of chronic inflammatory bowel disease.

Enteroaggregative Escherichia coli: another cause of acute and chronic diarrhoea in England?

Enteroaggregative Escherichia coli (EAggEC) has been found to be associated with acute and persistent diarrhoea in children in developing countries. Its clinical significance in developed countries has not been examined in much detail. In a survey of faecal samples from children with diarrhoea presenting to a children's hospital in East London between August and December 1988, EAggEC strains were isolated in 8 of 297 (2.

The association of maternal social class with maternal diet and the dimensions of babies in a population of London women.

Records of the diets of 513 London mothers towards the end of the first trimester of pregnancy have been reported previously to show the maternal nutritional intakes associated with birthweight in the optimum range, which may be assumed to approximate to basic maternal needs for reproduction. The diets associated with low birthweight and small head size were also recorded and were found to be inferior. The present paper shows social class gradients for baby size and 35 essential dietary components, providing an indication of which basic maternal nutritional needs were not always met.

Nutrition and health in relation to food production and processing.

Intensive animal rearing, manipulation of crop production and food processing have altered the qualitative and quantitative balance of nutrients of foods consumed by Western society. This change, to which the physiology and biochemistry of man may not be presently adapted to, is thought to be responsible for the chronic diseases that are rampant in the Industrialised Western Countries. Agriculture production and food processing practices, dietary habits and lifestyle of the West is being fostered without any appraisal of the health implications by most developing countries.

Diarrhoeal disease: current concepts and future challenges. Malnutrition and infection.

In individual children in developed countries it is possible to follow a sequence of infection of the gastrointestinal tract leading to chronic diarrhoea which, if it long persists, may in turn lead to undernutrition. Both in individuals and epidemiologically in developing countries it is, by contrast, often difficult to be certain whether infection precedes under-nutrition or vice versa. Chronic diarrhoea is heterogeneous and aetiology varies from community to community.