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Biomedical subjects

A Paerregaard

Publications and source records attributed to A Paerregaard.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Esophago-gastro-duodenoscopy of pediatric patients].

In total 199 oesophago-gastro-duodenoscopies (OGD) were performed in 71 female and 71 male paediatric patients (three months-15 years, median 8 years 2 months). The endoscopy was performed in general anaesthesia in children less than five years old, and in an intravenous sedation in older patients. The indications for OGD were: recurrent abdominal pain and concomitant positive antibodies against Helicobacter pylori as a part of a scientific project, upper dyspepsia, upper gastrointestinal bleeding, failure to thrive, coeliac disease, suspicion of chronic inflammatory bowel disease and a percutaneous gastrostomy. Seventy-two OGD were carried out in general anaesthesia, 86 in intravenous sedation with midazolam and pethidine and 41 in intravenous midazolam sedation. Complications related to the sedation or to the endoscopy were not observed. Amnesia was reported in 94/95 children who were sedated intravenously with midazolam and pethidine or midazolam alone. Six endoscopies could not be carried out in intravenous sedation because of agitation. In the primary OGD endoscopy revealed a normal mucosa in 121/142 (85%), oesophagitis in four (3%), nodular mucosa in six (4%), gastritis in four (3%) and a duodenal ulcer in one (0.7%). Histology disclosed active or inactive chronic gastritis at the primary endoscopy in 35/69 (51%) of the children with recurrent abdominal pain and antibodies against H. pylori. In children with failure to thrive an avillous duodenal mucosa was seen in 3/32 (9%). A comparison between histological and stereomicroscopical evaluation of the duodenal biopsies revealed agreement in 41/47 (87%). We conclude that OGD is a safe and tolerable procedure in paediatric patients, in whom possible morphological changes are suspected. The indications for an OGD need further evaluation.

Abdominal Pain↗
PubMed1997

[Pathogenic intestinal bacteria: adhesion and invasion].

Enteric bacterial pathogens cause considerable morbidity and mortality in developing countries. However, also industrialised countries are burdened with these microorganisms, and there is an increasing public awareness of the problems associated with foodborne diarrhoeal diseases. The ability to interact with the gut epithelium is essential for these bacteria. During the last 10-15 years our insight into the mechanisms for bacterial adhesion and invasion has increased dramatically, and, based upon this, new strategies for prevention and treatment of diarrhoeal diseases have been suggested. This review summarises the present general knowledge about bacterial adhesion and invasion in the gut and gives details for bacteria, that are recognised enteric pathogens. Examples are given about possible future use of this knowledge in the prevention or treatment of diarrhoeal disease.

Bacterial Adhesion↗
PubMed1997

Abdominal ultrasonography in the diagnostic work-up in children with recurrent abdominal pain.

UNLABELLED: We report on our experience with routine abdominal ultrasonography in 120 children (aged 3-15 years) with recurrent abdominal pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities: gallbladder stone (n = 2), splenomegaly (n = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases. CONCLUSION: The diagnostic value of abdominal ultrasonography in unselected children with recurrent abdominal pain is low. However, the direct visualization of the abdominal structures as being normal may be helpful to the parents and the child in their understanding and acceptance of the benign nature of recurrent abdominal pain.

Abdominal Pain↗
PubMed1997

Disseminated infection with Bacillus Calmette-Guerin in a child with advanced HIV disease.

An 8-month-old boy with vertically acquired HIV-infection who developed a disseminated BCG infection is described. The patient had been immunized at birth with BCG. In spite of a normal CD-4 lymphocyte count, he suffered from fever, anaemia and failure to thrive. BCG was isolated by culture from CSF, bone marrow and peripheral blood. Anti-tuberculous treatment initially seemed successful, but shortly after, the patient died from Pneumocystis carinii pneumonia. In symptomatic HIV-infected children originating from countries with BCG immunization programs, disseminated BCG infection should be considered.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Infections with mycobacteria other than M. tuberculosis in children].

We reviewed case records of 22 children who were diagnosed as having nontuberculous mycobacterial infection. All children were previously healthy. In 20 cases the infection presented as cervical lymphadenitis. The patients were between ten months and 14 years old, and two thirds were between 13 and 36 months old. The majority (74%) were girls. Mycobacterium avium/intracellulare was isolated most frequently (55%). The report describes the diagnosis and treatment of childhood mycobacterial cervical adenopathy. All patients except one were treated surgically. We found considerable differences in both preoperative and operative management. When excision of the lymph node (as opposed to needle biopsy) was performed, diagnosis could be made earlier and repeated surgical procedures could be avoided.

Child, Preschool↗
PubMed1996

[Gastrointestinal mucus].

Gastrointestinal mucus (GIMu) is a viscoelastic gel, which covers the surface of the entire digestive tract. The main component of GIMu is mucin, which is a high molecular weight glycoprotein. Mucin is composed of a central peptide core with polysaccharide chains arranged radially from the core ("bottle brushappearance"). The carbohydrates are very hydrophilic and, therefore, able to bind large amounts of water, which partly accounts for the gel-forming properties of GIMu. GIMu has an important function as a barrier against large particles, H+ ions and pepsin, carcinogens, certain macromolecules and microorganisms. GIMu seems to be involved in the pathogenesis of gastroduodenal ulceration, inflammatory bowel disease, gastrointestinal malignancies, gallbladder stones and infectious diarrhoeal diseases. GIMu is also an important factor in maintaining the normal microbial intestinal homeostasis. In the future, a more detailed knowledge about the molecular structure and function of GIMu may lead to new diagnostic and therapeutic strategies for gastrointestinal diseases.

Gastric Mucosa↗
PubMed1996

Long term outcome of prophylaxis for febrile convulsions.

A cohort of 289 children with febrile convulsions who had been randomised in early childhood to either intermittent prophylaxis (diazepam at fever) or no prophylaxis (diazepam at seizures) was followed up 12 years later. The study focused on the occurrence of epilepsy and on neurological, motor, intellectual, cognitive, and scholastic achievements in the cohort. At follow up the two groups were of almost identical age (14.0 v 14.1 years), body weight (58.2 v 57.2 kg), height (168.2 v 167.7 cm), and head circumference (55.9 v 56.2 cm). The occurrence of epilepsy (0.7% v 0.8%), neurological examination, fine and gross motor development on the Stott motor test, intellectual performance on the Wechsler intelligence scale for children verbal IQ (105 v 105), performance IQ (114 v 111), and full scale IQ (110 v 108), cognitive abilities on a neuropsychological test battery, including short and long term, auditory and visual memory, visuomotor tempo, computer reaction time, reading test, and scholastic achievement were also very similar. Children with simple and complex febrile convulsions had the same benign outcome. The long term prognosis in terms of subsequent epilepsy, neurological, motor, intellectual, cognitive, and scholastic ability was not influenced by the type of treatment applied in early childhood. Preventing new febrile convulsions appears no better in the long run than abbreviating them.

Adolescent↗
PubMed1995

[Periorbital and orbital cellulitis in children].

During a six-year period 28 febrile children with acute periorbital swelling were identified. Median age was 1.8 years (range, two weeks-nine years). When possible, the children were classified as having preseptal cellulitis (infectious focus in the subcutaneous tissue in front of the orbital septum) or postseptal cellulitis (focus in the paranasal sinuses). In six children a diagnosis of preseptal subcutaneous cellulitis was based upon the clinical presentation and positive culture results. Five children were additionally classified as having preseptal cellulitis due to severe conjunctivitis. Fifteen children were classified as having postseptal cellulitis due to infection in the paranasal sinuses (ethmoiditis). In seven of the latter cases the diagnosis was based upon the results of CT/MR-scans or operation. Two children could not be classified. All children were given antibiotic treatment and four had an operation. There were no recurrences or sequelae. In our study a presumed diagnosis could be made in retrospect in most cases, but at the time of presentation the clinical picture was often confusing. We found a CT- or MR-scan to be most helpful, especially in identifying the children requiring surgical treatment.

Cellulitis↗
PubMed1993

[Giardiasis in children with chronic diarrhea. Incidence, growth, clinical symptoms and changes in the small intestine].

During a six-year period, 29 children (aged 0.7-13.5 years, mean 3.3 years) suffering from chronic diarrhoea due to giardiasis were studied. The incidence of this illness was 81 per 1,000,000 per year among children aged 0- < 7 years. According to growth charts, relative height and weight of the patients decreased significantly (both approximately 0.5 SD) from before the onset of diarrhoea to the time of diagnosis and subsequently increased up to the end of catch-up growth. Small intestinal mucosal specimens were studied. Two patients had severe villous atrophy, 8 moderate abnormalities, 6 only slight changes and 13 biopsies were normal. D-xylose or lactose malabsorption was detected in 25% of the patients. The lactose malabsorption was due to hereditary low lactase levels. None of the patients with a Danish ethnic background showed lactose malabsorption. D-xylose absorption and the relative weight loss of the patients correlated with the degree of mucosal damage. Patients with persistent diarrhoea (n = 19) were younger and had a shorter duration of diarrhoeal illness and a more significant weight reduction than those with intermittent diarrhoea (n = 10). However, the age at onset of symptoms was similar in the two groups (medians 1.3 years). Seven patients contracted the disease abroad. They all developed persistent diarrhoea and had a more severe course of the illness than those who acquired the disease in Denmark.

Adolescent↗
PubMed1992

Giardiasis: haematological status and the absorption of vitamin B12 and folic acid.

The haematological status, as well as the fractional absorptions of folic acid (FAFol) and vitamin B12 (FAB12) were studied in 29 children aged 0.7-13.5 years (mean 3.3 years) with chronic diarrhoea due to giardiasis. Small intestinal biopsies revealed mucosal damage in 20 children; the biopsies of the remaining nine children were normal. At the initial investigation the FAFol and FAB12 values were below normal in approximately one-sixth and one-third of patients, respectively. Bacterial overgrowth of the small intestinal tract did not seem to play a role in FAB12 malabsorption. About one-fifth of patients had mild anaemia. None of the patients showed FAB12 insufficiency and only one patient suffered from folate depletion. At follow-up, FAFol, FAB12, haemoglobin and Erc-folate concentrations increased significantly while P-B12 and P-folate remained unchanged. Iron status, as well as dietary intake of iron, appeared insufficient prior to, as well as after treatment. Serum iron, transferrin saturation and haemoglobin concentrations were lower in patients who had acquired the disease abroad or suffered from persistent diarrhoea.

Child↗
PubMed1992

Giardiasis causing chronic diarrhoea in suburban Copenhagen: incidence, physical growth, clinical symptoms and small intestinal abnormality.

During a six-year period, 29 children (aged 0.7-13.5 years, mean 3.3 years) suffering from chronic diarrhoea due to giardiasis were studied. The incidence of this illness was 81 per 1,000,000 children aged 0- < 7 years per year. According to growth charts, relative height and weight of the patients decreased significantly (approximately 0.5 SD) from before the onset of diarrhoea to the time of diagnosis and subsequently increased up to the end of catch-up growth. Small intestinal mucosal specimens were studied. Two patients had severe villous atrophy, 8 moderate abnormalities, 6 only light changes and 13 biopsies were normal. D-xylose or lactose malabsorption was detected in 25% of the patients. The lactose malabsorption was due to hereditary low lactase levels. None of the patients with a Danish ethnic background showed lactose malabsorption. D-xylose absorption and the relative weight loss of the patients correlated with the degree of mucosal damage. Patients with persistent diarrhoea (n = 19) were younger and had a shorter duration of diarrhoeal illness and a more significant weight reduction than those with intermittent diarrhoea (n = 10). However, the age at onset of symptoms was similar in the two groups (medians 1.3 years). Seven patients contracted the disease abroad. They all developed persistent diarrhoea and had a more severe course of the illness than those who acquired the disease in Denmark.

Adolescent↗
PubMed1992

Interactions between Yersinia enterocolitica and the host with special reference to virulence plasmid encoded adhesion and humoral immunity.

This thesis is based on 8 publications and a review of the literature. The aim was to summarize present knowledge on molecular components of Yersinia enterocolitica involved in (i) adhesion, with special reference to plasmid encoded factors and (ii) induction of antibodies in the host, and the quantitation of these two phenomena. Adhesion of Y. enterocolitica was quantitatively studied by methods that measured binding to cultured epithelial cells, mucosal constituents immobilized on polystyrene, intestinal tissue, and nonbiological solid surfaces. The chromosomal inv and ail gene products have been shown by others to be independently able to mediate adhesion to and invasion of cultured epithelial cells. However, the Yersinia virulence plasmid, pYV, also encodes for at least one product that may mediate adhesion. It was shown that pYV carrying Y. enterocolitica strains adhered more efficiently than their isogenic pYV cured derivatives to rabbit and human ileal intestinal tissue and to rabbit ileal brush border membrane vesicles (BBVs). Using Y. enterocolitica mutants that were defective for production of the pYV encoded outer membrane protein, YadA, and Escherichia coli strains carrying the cloned yadA gene it was verified that YadA was responsible for the pYV encoded adhesion. The YadA promoted adhesion was found likely to be non-specific and, at least in part, mediated by hydrophobic interaction. YadA, however, also mediated binding to one or more constituents present in intestinal mucus. Such binding led to decreased ability to penetrate a layer of mucus in vitro and subsequent decreased ability to adhere to BBVs. Based upon these results, it remains uncertain whether Y. enterocolitica is able to benefit from the YadA mediated adhesion in the intestinal millieu. In vivo results have suggested that expression of YadA confers on Y. enterocolitica an increased ability to colonize the intestine, but no definitive conclusions have been reached so far. A large number of antigens were identified in Y. enterocolitica by means of crossed immunoelectrophoresis (XIE). Quantitation of serological cross-reactions between chromosome-encoded Y. enterocolitica antigens and antigens from other bacterial species was performed by means of XIE and proved useful for taxonomic purposes. Using XIE it was shown that infection with Y. enterocolitica induced an antibody response against a wide range of antigens. Tube agglutination, enzyme linked immunosorbent assays (ELISAs) using purified lipopolysaccharide (LPS) or formalin-killed whole pYV carrying cells as antigens, and XIE were evaluated for their applicability to detect recent Y. enterocolitica O:3 infection.(ABSTRACT TRUNCATED AT 400 WORDS)

Antibodies, Bacterial↗
PubMed1991

[Neonatal sepsis at Rigshospitalet in 1984-1988].

Eighty-one episodes of bacteremia and candidemia were recorded in 78 infants in our neonatal intensive care unit during the years 1984 to 1988. The species isolated from monomicrobial episodes were as follows: Enterobacteriaceae 38%, group B streptococci or pneumococci 12%, staphylococci 20%, Candida albicans 9%, and other species 15%. Polymicrobial bacteremia occurred in 6%. Group B streptococci and pneumococci were predominantly isolated from early infections, whereas Enterobacteriaceae, Staphylococcus epidermidis and C. albicans were associated mainly with late septicemia. More than 80% of the episodes occurred in premature infants. During the study period, initial empiric antibiotic therapy consisted of ampicillin plus gentamicin. In spite of the fact that Enterobacteriaceae isolates, often ampicillin resistant, and penicillinase producing staphylococci, were the dominant etiologic agents, choice of this initial therapy did not seem to contribute to mortality. Mortality was most convincingly associated with overwhelming infections caused by group B streptococci and pneumococci.

Anti-Bacterial Agents↗
PubMed1991

A diagnostic problem in tuberculous dactylitis.

We report a case of tuberculous dactylitis. This rare manifestation of extra-pulmonary tuberculosis must be kept in mind in the diagnosis of a slowly-growing bone tumour. The diagnostic problems and pitfalls are discussed.

Child↗
PubMed1991

Measurement of calbindin-D9K in small intestinal biopsy specimens of children.

The vitamin D dependent intestinal calcium-binding protein (calbindin-D9K) was measured by an enzyme-linked immunoadsorbent assay in small intestinal biopsy specimens from 10 children (aged 15-126 months). The aim was to study the relationship between calcium-binding protein and age, bone age, and height. The patients were examined due to complaints of chronic diarrhea, but no evidence of malabsorption was found. The amount of calbindin-D9K per mg of soluble protein in the small intestinal biopsy specimens was higher than previously studied in normal adults. Calbindin-D9K correlated inversely with chronological age, bone age, and height of the children (p = -0.87, rho = -0.66, and rho = -0.66; p less than 0.05). A direct correlation was found between calbindin-D9K and intestinal alkaline phosphatase activity (p = 0.60; p less than 0.05). The decline in calbindin-D9K may indicate that the active vitamin D dependent intestinal calcium absorption decreases during childhood.

Age Determination by Skeleton↗
PubMed1991

Role of the Yersinia outer membrane protein YadA in adhesion to rabbit intestinal tissue and rabbit intestinal brush border membrane vesicles.

The Yersinia virulence plasmid confers on strains of Yersinia pseudotuberculosis and Y. enterocolitica an adhesive potential superior to the one encoded by the chromosome alone. We have evaluated the role of the plasmid-encoded outer membrane protein YadA (formerly called Yopl) in adhesion. Insertional inactivation of the yadA gene (formerly called yopA), which encodes YadA, led to a reduction in the capacity of plasmid-carrying strains of Y. pseudotuberculosis 0:III and Y. enterocolitica 0:9 to adhere to intestinal tissue, brush border membranes and polystyrene surfaces. The adhesive characteristics of the mutants were comparable to those of their plasmid-cured counterparts. When the yadA gene from Y. pseudotuberculosis serotype 0:III or Y. enterocolitica serotype 0:3 or 0:8 was cloned into an Escherichia coli strain, increased ability to adhere to intestinal tissue, brush border membrane vesicles and polystyrene was transferred concomitantly. The introduction of the yadA gene from Y. pestis, which is unable to express YadA due to a one base pair deletion, did not change the adhesive characteristics of E. coli. Expression of YadA in the outer membrane may, therefore, make an important contribution to intestinal adherence of the two enteropathogenic members of the Yersinia species, Y. pseudotuberculosis and Y. enterocolitica.

Animals↗
PubMed1991

Interactions between Yersinia enterocolitica and rabbit ileal mucus: growth, adhesion, penetration, and subsequent changes in surface hydrophobicity and ability to adhere to ileal brush border membrane vesicles.

Interactions between Yersinia enterocolitica and rabbit ileal mucus were examined. Strains carrying the Yersinia virulence plasmid, pYV, adhered to crude mucus but not to intestinal luminal contents that had been immobilized on polystyrene. Using an Y. enterocolitica O:9 mutant in which the yadA gene (formerly called yopA), encoding the high-molecular-weight outer membrane protein YadA (formerly called protein P1 or Yop1), had been inactivated and an Escherichia coli strain carrying the cloned yadA gene, we demonstrated that the ability to adhere to mucus correlated closely to expression of YadA. Thereafter, we evaluated possible consequences of binding between pYV-carrying Y. enterocolitica O:3 strains and constituents in the mucus layer. pYV-carrying strains were able to multiply at a high rate in mucus but not in luminal contents, and the ability to adhere to mucus could therefore facilitate bacterial colonization of the mucosa. However, we also showed in vitro that mucus acted as a barrier for a mucus-adherent, pYV-carrying Y. enterocolitica strain. Furthermore, penetration through, or preincubation with, mucus reduced subsequent adhesion of the pYV-carrying strain to brush border membrane vesicles without simultaneously causing bacterial aggregation. Preincubation with mucus also changed the bacterial surface of the same strain from hydrophobic to hydrophilic. Immunoglobulins present in mucus did not seem to be of importance for our observations. Interaction of Y. enterocolitica with intestinal mucus may thus reflect a host defense mechanism that reduces the pYV-mediated adhesion to the epithelial cell membrane, possibly by rendering the bacteria less hydrophobic.

Animals↗