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Biomedical subjects

K Hjelt

Publications and source records attributed to K Hjelt.

At least 37 records · Page 2Linked to original sources
PubMed1990

The age-related incidence of meconium ileus equivalent in a cystic fibrosis population: the impact of high-energy intake.

During the decade from 1976 to 1986, the age-related incidence of meconium ileus equivalent (MIE) was calculated on the basis of 240 Danish cystic fibrosis (CF) patients. In the first 5 years, the patients were given enteric-coated granules of pancreatic enzymes (Pancreatin, Rosco, Denmark), and a low fat diet was recommended. In the last 5 years, the Center recommended supplementation with acid-resistant, enteric-coated, encapsulated microspheres (Pancrease, Cilag, Birkerød, Denmark), and high-energy intake with a 40% fat content and no dietary restrictions. There was no difference in the incidence of MIE when these two 5-year periods were compared, and the overall incidence of MIE was low (5.4 MIEs/1,000 patient years). This may, at least in part, be due to the rather high intake of exocrine pancreas enzyme supplementation (EPES) (a mean intake of 0.9 capsules/kg/day). MIE occurred almost exclusively among patients greater than 15 years old and peaked in young adults aged 20-25 years (35.5 MIEs/1,000 patient years). The daily intake of EPES/kg of body weight declined significantly with age, and the patients who developed MIE received even less than average per day. Both of these points strengthen the view that a low enzyme dosage is likely to have an effect on the incidence of MIE.

Acetylcysteine↗
PubMed1990

The impact of gluten on haematological status, dietary intakes of haemopoietic nutrients and vitamin B12 and folic acid absorption in children with coeliac disease.

The haematological status, as well as the fractional absorptions of folic acid-and of vitamin B12 (FAFol and FAB12) were studied longitudinally in 20 coelic children aged 1.2-16.6 yr (mean 7.5 yr) during periods of gluten-free and gluten containing diets. The absorption methods were specially adapted to use in children, and age-related reference limits were established. Also, dietary intakes of iron, folate and B12 were registered. The haemoglobin concentrations did not show any significant differences in relation to shifts in diet. A few had mild anaemia while the haemoglobin concentrations in the other patients remained within normal range. The iron status, as judged from mean corpuscular volume (MCV), serum (S)-iron, S-transferrin and saturation %, appeared to be generally insufficient. However, the only significant change related to shifts in diet was an increase of S-iron during the first period of gluten-free diet. Dietary intakes of iron proved to be insufficient, regardless of the type of diet. Plasma (P)-B12 concentrations demonstrated a wide range of values above the lower normal limit, whereas the level in a single patient was within the "intermediate range" of B12 insufficiency (150-200 pmol/l). The folate status (erythrocyte-folate) showed significant variations related to dietary changes. However, few patients were folate depleted. FAFol and FAB12 demonstrated rapidly occurring, and significant decreases and increases in relation to gluten challenge and gluten-free diet, respectively. Bacterial overgrowth of the small intestinal tract was not found to be a plausible cause of the B12 malabsorption in the case of 5 patients observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Postenteritis enteropathy in infancy. A prospective study of 10 patients with special reference to growth pattern, long-term outcome and incidence.

Ten patients, who developed postenteritis enteropathy with chronic diarrhoea, failure to thrive and small intestinal mucosal damage after an episode of acute gastroenteritis, were studied prospectively. All patients experienced severe growth retardation. Maximum deviation of height and weight from mean values of age-correlated normal children were -1.7 and -3.1 SD (median values), respectively, as compared to -0.1 and 0 SD before onset of the illness. One child died after 14 months of illness. The long-term outcome was satisfactory for the 9 surviving children. For these children, treatment with an elemental diet (in some cases supplemented initially with parenteral nutrition) and later a lactose-free diet lead to resolution of diarrhoea within periods ranging from 0.5 to 10 months. The phase of catch-up growth lasted from 4 to 36 months, resulting in final height and weight deviating -0.6 and -0.8 SD (median values), respectively, from normal mean values. Attempt to predict duration of diarrhoea or length of catch-up growth phase by means of age, weight before illness, characteristics of small intestinal biopsy or maximum deviation of height or weight were unsuccessful. The incidence of postenteritis enteropathy for children of North European ethnic origin was estimated to be 7.6/1,000,000 children below 7 years of age/year, corresponding to 1.2/1,000 children hospitalized for acute gastroenteritis.

Chronic Disease↗
PubMed1990

Nitrofurantoin versus trimethoprim prophylaxis in recurrent urinary tract infection in children. A randomized, double-blind study.

The efficiency of nitrofurantoin and trimethoprim prophylaxis in preventing recurrent urinary tract infections (UTI) was compared by means of actuarial percentage recurrence-free curves in a randomized, double blind study in 130 children (126 girls, 4 boys) aged 1 to 14 years (mean 7.5). The children received the antibiotics for 6 months. Nitrofurantoin proved to be the most efficient prophylactic drug in patients with abnormal urography and/or reflux (n = 60) as evaluated by actuarial percentage recurrence-free analysis (p = 0.0025). However, no differences was found in patients without urinary tract abnormalities. Nitrofurantoin prophylaxis altered neither the pattern of resistance nor the bacteriological constellation, while patients receiving trimethoprim prophylaxis had 76% trimethoprim resistant bacteria during prophylaxis, compared with 8% before (p less than 0.0001) and 17% after (p less than 0.0001) prophylaxis. The percentage of recurrences due to E. coli (70-80%) was unaffected by trimethoprim prophylaxis, but the proportion due to trimethoprim resistant E. coli was significantly higher during prophylaxis (65%) than before (6%, p less than 0.0001) and after (11%, p less than 0.001). The percentage of Staphylococcus epidermidis UTI was significantly higher during trimethoprim prophylaxis (27%) than before (2%, p less than 0.0003). Following prophylaxis there was no difference in the actuarial percentage recurrence-free curves of the two regimens. Side effects occurred more frequently in the nitrofurantoin group (37%) than in the trimethoprim group (21%) (p = 0.05). The majority of side effects in the nitrofurantoin group derived from gastrointestinal symptoms. In conclusion, nitrofurantoin is recommended as the first choice prophylactic treatment of children with recurrent UTI and urinary tract abnormalities.

Adolescent↗
PubMed1989

[Meconium ileus equivalent].

Meconium ileus equivalent (MIE) can be defined as a clinical manifestation in cystic fibrosis (CF) patients caused by acute intestinal obstruction by putty-like faecal material in the cecum or terminal ileum. A broader definition includes a more chronic condition in CF patients with abdominal pain and a coecal mass which may eventually pass spontaneously. The condition occurs only in CF patients with exocrine pancreatic insufficiency (EPI). It has not been seen in other CF patients nor in non-CF patients with EPI. The frequency of these symptoms has been reported as 2.4%-25%. Pathophysiologically, MIE is probably caused by a combination of EPI, increased intestinal transit time, and abnormal intestinal mucus. The treatment should primarily be non-operative. Specific treatment with N-acetylcysteine, administrated orally and/or as an enema is recommended. Enemas with the water soluble contrast medium, meglucamine diatrizoate (Gastrografin), provide an alternative form for treatment and can also serve diagnostic purposes. It is important that the physician is familiar with this disease entity and the appropriate treatment with the above mentioned drugs. Non-operative treatment is often effective, and dangerous complications following surgery can thus be avoided.

Adult↗
PubMed1989

Rapid versus gradual refeeding in acute gastroenteritis in childhood: energy intake and weight gain.

Fifty-two children aged 6-46 months (mean 19 months), hospitalized for acute gastroenteritis (GE), were randomized after oral rehydration to receive 7 days of either traditional gradual refeeding (GR) or rapid refeeding (RR), the latter consisting of a full-strength lactose-limited diet, including lactase-treated whole milk. The study focused on the effect of a high energy intake, excluding possible negative effects of lactose. Both dietary regimens were well tolerated, the only difference in the clinical symptoms between the two regimens being a higher stool frequency within the RR group (p less than 0.02). The total energy intake, as well as energy derived from fat and protein, was significantly higher in the RR than in the GR group (p less than 0.0001). The mean daily energy intake of the latter group never reached recommended daily allowance (RDA) levels, while that of the RR group did on day 5. Moreover, during the whole period of dietary regimen, the RR group exceeded the RDA protein requirements (mean intake ranged 175-252%), while the GR group did not reach this RDA level until day 4. Milk was a major source of energy in the RR group, providing 47-59% of the daily energy intake. The short- and long-term weight gains in the RR group were only a little higher than those of the GR group, the difference being insignificant.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

Folic acid absorption determined by a single stool sample test--a double-isotope technique. The folic acid absorption capacity in children.

The fractional folic acid absorption (FAFol) was determined in 66 patients with various gastrointestinal diseases by a double-isotope technique, employing a single stool sample test (SSST) as well as a complete stool collection. The age of the patients ranged from 2.5 months to 16.8 years (mean 6.3 years). The test dose was administered orally and consisted of 50 micrograms of [3H]folic acid (monoglutamate) (approximately 20 muCi), carmine powder, and 2 mg 51CrCl3 (approximately 1.25 muCi) as the unabsorbable tracer. The whole-body radiation given to a 1-year-old child averaged 4.8 mrad only. The stool and napkin contents were collected and homogenized by the addition of 300 ml chromium sulfuric acid. A 300-ml sample of the homogenized stool and napkin contents, as well as 300 ml chromium sulfuric acid (75% vol/vol) containing the standards, were counted for the content of 51Cr in a broad-based well counter. The quantity of [3H]folic acid was determined by liquid scintillation, after duplicate distillation. Estimated by SSST, the FAFol, which employs the stool with the highest content of 51Cr corresponding to the most carmine-colored stool, correlated closely with the FAFol based on complete stool collection (r = 0.96, n = 39, p less than 0.0001). The reproducibility of FAFol determined by SSST was assessed from repeated tests in 18 patients. For a mean of 81%, the SD was 4.6%, which corresponded to a coefficient of variation of 5.7%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

Sensitivity to tuberculin and sensitins from atypical mycobacteria (M. chelonae subsp. abscessus, M. avium, M. intracellulare, M. scrofulaceum) in 100 Danish school children.

One hundred non-BCG vaccinated Danish school children aged 7.3-14.9 yrs (median 12.8 yrs) were studied with regard to the size of skin induration 72 hrs following intracutaneous injections of 1 unit of tuberculin PPD and 0.1 microgram of four different sensitins produced from M. chelonae subsp. abscessus. M. avium, M. intracellulare and M. scrofulaceum. Fifteen children showed at least one significant reaction (i.e. skin induration greater than 6 mm). Of these children, 13 had two or more significant reactions. None of the children showed primary reactions to tuberculin; but the tuberculin reaction in one child was significant, whereas five other children had detectable tuberculin reactions, all being due to cross reactions to atypical mycobacteria. In addition to the atypical mycobacteria, the following frequencies of significant reactions were found: M. chelonae subsp. abscessus (6%), M. avium (11%), M. intracellulare (13%), M. scrofulaceum (12%). The reactions to the 5 skin tests were significantly different (p less than 0.001). However, the skin reactions to M. avium, M. intracellulare and M. scrofulaceum (i.e. the MAIS complex) were similar, and they correlated significantly (p less than 0.001). On the other hand, the members of the MAIS complex correlated with neither M. tuberculosis nor with M. chelonae subsp. abscessus, and the reactions to these two atypical mycobacteria were significantly different (p less than 0.01). This seems to indicate extensive cross reactions between the members of the MAIS complex. Consequently, cutaneous testing for this complex in epidemiological surveys only requires a skin test with one of the members.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Protective effect of preexisting rotavirus-specific immunoglobulin A against naturally acquired rotavirus infection in children.

The preexisting levels of rotavirus IgA and IgG were measured in 225 children aged 6 months to 7 years in November, ie, before the "rotavirus season" from January to April. During the following 6 months, all episodes of acute gastroenteritis (GE) were evaluated clinically according to a score system and feces was examined for rotavirus, pathogenic bacteria, and parasites. Furthermore, rotavirus GE (n = 45) as well as asymptomatic rotavirus infections (n = 29) were diagnosed serologically. The preexisting concentrations of rotavirus IgA and IgG measured by ELISA were similar in these two groups. However, preexisting rotavirus IgA in the group of children who developed rotavirus GE correlated with less severe symptoms. Thus vomiting was found in 24% and 63% of the children with detectable and undetectable rotavirus IgA, respectively (P less than 0.025). Moreover, according to the total symptom score of rotavirus GE, 52% of the children with detectable preexisting rotavirus IgA had mild symptoms compared with only 13% of those with undetectable concentrations (P less than 0.025). Rotavirus IgG did not have any protective effect. Age per se had a protective effect; older age (greater than 1.5 years) was related to mild symptoms. According to previous studies of local and intestinal antibody response to a rotavirus GE, it is suggested that rotavirus IgA in serum reflects the immunological status of the intestine concerning rotavirus. It is recommended that studies of rotavirus vaccines include rotavirus IgA response and its protective effect.

Acute Disease↗
PubMed1987

Acute gastroenteritis in children attending day-care centres with special reference to rotavirus infections. I. Aetiology and epidemiologic aspects.

Acute gastroenteritis (GE) among 214 children (aged 6 months-7 years) attending day-care centres (DDCs) in the Copenhagen County was studied during a 12-month period. A total of 197 cases of GE was observed in 109 children (i.e. 51% of the participants). The aetiology was as follows: rotavirus (n = 48) (24%), pathogenic bacteria (n = 11) (6%), Giardia lamblia (n = 3) (2%), while the aetiology of 68% remains unknown. The pathogenic bacteria included Yersinia enterocolitica, thermophilic Campylobacter, Clostridium difficile (+/- toxin) and enteropathogenic E. coli. In 4% of the GE the infections were multiple and Cryptosporidium was seen in one of these cases. The rate of GE declined with age from 1.35 GE per child per year (age group 1.0- less than 2.0 years) to 0.36 (6.0- less than 8.0 years). Serum sampled at the start of the study period showed that the frequency of detectable rotavirus IgG increased with age from 48% in the 6 months- less than 1.0 year group to 96% in the 4.0- less than 7.0 year group. The highest rates of rotavirus GE occurred from January to April (i.e. the rotavirus season). Moreover, rotavirus GE was almost absent after the age of 4. Hence, the rates of rotavirus GE per rotavirus season per child were 0.80 (age group 6 months-less than 1.0 year), 0.32 (1.0-less than 2.0), 0.14 (2.0-less than 3.0), 0.16 (3.0-less than 4.0), 0.06 (4.0-less than 5.0) and 0.04 (5.0-less than 6.0). Only 2 out of the 48 rotavirus GE were reinfections.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1987

Acute gastroenteritis in children attending day-care centres with special reference to rotavirus infections. II. Clinical manifestations.

In a prospective study of a cohort of 214 children (aged 6 months-7 years) attending day-care centres, a total of 197 episodes of acute gastroenteritis (GE) occurred in 109 children (i.e. 51% of the participants) during a 12-month observation period. Rotavirus, pathogenic bacteria and Giardia lamblia caused GE in 24%, 6% and 2% of the cases, respectively. The aetiology of the remaining 68% was not discovered. Generally, the symptoms of GE were light and only two episodes led to hospitalization. Thirty-two rotavirus infections were asymptomatic. Two rotavirus GE reinfections occurred. They showed less severe symptoms than the primary infections. The older children (greater than 1.5 years) with rotavirus GE had lighter symptoms than the younger ones (less than or equal to 1.5 years). Compared with children with non-rotavirus GE, those with rotavirus GE showed the following clinical features: (1) Age between 6 months and 2 years. (2) Occurrence of rotavirus GE almost exclusively during the rotavirus season, i.e. January to April (winter). (3) High frequency of vomiting, the onset of which often preceded that of diarrhoea. However, these signs did not form a safe basis for the clinical diagnosis of rotavirus GE. One or more upper respiratory manifestations (URM) were observed in 39% of the children with rotavirus GE and in 36% of those with non-rotavirus GE. The occurrence of URM was age-related being highest in children less than 2 years. Consequently, the existence of a rotavirus syndrome is questioned. It is argued that URM in children with rotavirus GE may be due to a co-infection of the upper respiratory tract by a different micro-organism.

Acute Disease↗