We present a case of recurrent bouts of irritability with arching, head extension, and lethargy in a previously healthy 10-month-old girl admitted to the PICU for acute onset of a movement disorder. The patient's vital signs and physical examination were unremarkable but recurrent bouts of abnormal movements persisted for the first 10 hours of admission in the PICU. Possible diagnoses, such as meningitis, status epilepticus, space occupying lesions, and toxic ingestions, were ruled out because of negative cerebrospinal fluid analysis, normal EEG, and negative results of other ancillary tests. On the second day of admission, an abdominal radiograph was obtained because intussusception was considered a probable diagnosis due to recurrent episodes of arching and lethargy. The abdominal radiograph revealed the presence of a 15-mm radiopaque foreign body in the right lower quadrant corresponding to the anatomic location of the ileocecal valve. The patient made an uneventful recovery after she spontaneously passed a 1.5 cm by 1 cm rock (15 mm) in her stool on the third day of admission. This case highlights the need for a high index of suspicion for unwitnessed ingestion of a foreign body in a previously healthy preschool child with sudden onset of a movement disorder.

Childhood obesity has been associated with elevated serum levels of total cholesterol, triglycerides, and low-density lipoproteins (LDLs). We observed the lipid profiles of obese female subjects versus obese male subjects before and after significant weight loss.We studied 29 girls and 21 boys enrolled in a multidisciplinary weight reduction program.Measures were taken at enrollment and at 10 weeks. Significant improvements were observed for changes in percentage of ideal body weight and total cholesterol and triglyceride levels. In addition, LDL decreased significantly in girls but not in boys.A combination of diet, behavior modification, and exercise, is an effective instrument for lowering total cholesterol and triglyceride levels in obese children. In addition, girls tend to be more susceptible to a decrease in LDL level, which might result in an increased cardiovascular protective effect.

Infiltration of the stomach wall by air, first described by Fraenkel in 1889 [3], is a very rare condition. We describe the first reported case of gastric pneumatosis occurring in a child with complex congenital heart disease after cardiac surgery.

Inflammation of the gastric and duodenal mucosa is the end result of an imbalance between mucosal defensive and aggressive factors. The degree of inflammation and imbalance between defensive and aggressive factors can then result in varying degrees of gastritis and/or mucosal ulceration. Gastritis and ulcers of the duodenum or stomach can be classified as primary or secondary. The majority of children with chronic gastritis and ulcers in the stomach or duodenum have secondary inflammation or mucosal ulceration. These secondary ulcers generally occur due to a systemic condition like head trauma or overwhelming sepsis, or as sequelae to drug ingestion (i.e. non-steroidal anti-inflammatory agents), but secondary gastroduodenal ulcers can also occur in specific disease conditions such as Zollinger-Ellison syndrome or Crohn's disease. In almost all children with primary duodenal or gastric ulcers mucosal inflammation and, less frequently, ulceration is caused by a spiral shaped, gram-negative, microaerobic rod Helicobacter pylori. Recent epidemiological evidence has linked chronic H. pylori infection with the development of gastric carcinomas.

Childhood obesity is a devastating chronic disease with a rapidly increasing prevalence. Successful prevention and treatment of child- hood obesity is dependent on increasing the physical activity of obese youth; however, motivating the obese child to participate in physical activity is difficult. Structured and vigorous, aerobic-type activities are often prescribed, but obese children are often noncompliant. Obese and non-obese children respond differently physical activity, especially weight-bearing exercise. Obese chil- dren have a decreased exercise tolerance and movement may be uncomfortable and painful. Physical injury is common. The physi- ologic dysfunction caused by the condition of obesity in children becomes greater as the severity of the disease increases. This physiological impairment should be considered when prescribing treatment recommendations and guidelines to obese youth, espe- cially those with severe conditions. Int Pediatr. 1999;14(3):135-139.

Research indicates that prevention of adult obesity may be accomplished through the treatment of prediatric obesity. However, it is unclear whether treatment should begin during the early or later childhood years. We examined the one-year program retention and weight maintenance of 139 obese children(M=63, F=76; Age=12.11±2.6 yrs.; Range=7.1-17.6 yrs.) enrolled in a multidisciplinary pediatric weight management program. The one-year program consisted of a protein-sparing modified fast diet, followed by a balanced hypocaloric diet, nutrition education, behavior modification, and a moderate-intensity (45-55% VO2max), progressive exercise program. Measures of height, weight, percent of ideal body weight (%IBW), and body mass index (BMI) were obtained at baseline, ten weeks and one year. For statistical analysis, subjects were blocked by age as follows: 7-8 yrs., 9-10 yrs., 11-12 yrs., and 13+ yrs. A repeated measures one way analysis of variance indicated the the results in the table (%IBW, mean±S.D;*Baseline to 10 weeks and baseline to 1 year. 10 weeks to 1 year = N.S.).

BACKGROUND:The hemolytic-uremic syndrome (HUS) comprises hemolytic anemia, acute renal failure, and thrombocytopenia. It is the most frequent cause of acute renal failure in children.METHODS:This review is based on an extensive overview of the literature dealing with the HUS in children.RESULTS:HUS is the most common cause of acute renal failure in infants and young children and follows a diarrheal prodrome approximately 90% of the time. Nearly all postdiarrheal cases are caused by enterohemorrhagic E coli infections, in particular serotype O157:H7. Mortality is around 5%, and approximately 50% of survivors manifest some types of sequelae.CONCLUSION:Surveillance and contact investigation are important to control outbreaks, as well as early and aggressive treatment of symptomatic subjects to prevent mortality and severe complications, such as chronic renal disease.

Modified food starches were developed as a stabilizer, providing desirable consistency, texture, and storage ability. They are used primarily in strained and junior foods and, to a minor extent, in infant formulas. However, despite the fact that there is an increasing tendency to introduce solid foods to infants at a very early age, there is few long-term studies to delineate the effect of starch feeding on the growth of young infants. Modified food starches used by the food industry for infants and young children are of concern and there is an urgent need for additional data regarding their bioavailability, effect on nutrient absorption, intestinal changes, and toxic, mutagenic, and carcinogenic effects. Therefore, the inclusion of modified food starches should be used prudently and sparingly.

Protein Sparing Modified Fast Versus Dexfenfluramine Hydrochloride(Redux®) as a Treatment for Childhood Obesity in Male Adolescents 580

The effect of protein-sparing modified fast in obese children with insulin dependent MODY-type diabetes mellitus. 422

Male and female serum lipid profiles in pediatric patients enrolled in a multidisciplinary weight reduction program. † 579

In view of its potential risk for the development of gastrointestinal disease or even gastric cancer at a later age, the study ofHelicobacter pylori infection in childhood is gaining increasing importance andH. pylori infection is being considered a major issue of public health.H. pylori infection can be detected by a variety of methods. Because of its easy use, affordability, and overall availability, serology is the preferred diagnostic test, especially for large epidemiological studies. Based on our results, one might consider treating a child with recurrent abdominal pain and positive serology forH. pylori without further work-up, and only perform additional investigations when an anti-W.pylori therapy fails to resolve the complaints. According to this proposition, endoscopy of the upper gastrointestinal tract remains indicated in children if the noninvastive tests forHelicobacter pylori are negative in the absence of a diagnosis, or if symptomatology persists despite treatment.

Serum lipid profiles in pediatric patients enrolled in a multidisciplinary weight reduction program: differences between White and African-American children. † 578

Important inroads are being made into understanding the pathophysiology of diarrhea. Clear understanding of key mechanisms should suggest new approaches to combat disease. Exciting developments are occurring in terms of super-ORS solutions, particularly with the promise of short chained glucose polymers and glutamine. Perhaps the most important development is the prospect of a good rotavirus vaccine being available before the end of the decade.

Helicobacter pylori is responsible for one of the most frequently encountered infectious diseases worldwide. Helicobacter pylori infection can lead to the development of gastritis and peptic ulcer disease. The presence of Helicobacter pylori in the human stomach also represents an increased risk of gastric cancer and gastric lymphoma. Epidemiological data obtained in adults suggest that the actual colonization with Helicobacter pylori is in fact determined by childhood factors. Therefore, the pediatric age group represents the ideal target population for studies concerning the pathogenesis and epidemiology of Helicobacter pylori infection. The present work reflects our experience with regard to the diagnosis, epidemiology and pathogenesis of Helicobacter pylori infection in childhood.

Epidemiological data about the prevalence of Helicobacter pylori positivity are presented in a large population of symptom-free paediatric and adult patients in Belgium (n: 1180, age range: 1 to 40 years). The investigated patients belonged to different ethnic backgrounds and are representative for the general population of Brussels. The overall prevalence of Helicobacter pylori positivity was 18.0%. We observed a significant increase in the number of positive patients with advancing age, ranging from 6.4% in the youngest age group (1 to 5 years) to 36.4% in the age group from 36 to 40. Furthermore, a significantly higher prevalence was observed in non-Caucasian patients when compared to caucasian subjects, even if both groups were born in Belgium and have been living in the same area ever since (p < 0.001). We conclude that the overall prevalence of Helicobacter pylori positivity in asymptomatic subjects in Belgium should not be underestimated. Their number increases with age and there are significant ethnic differences. The meaning of these "asymptomatic carriers" still needs to be elucidated, but their prevalence should be considered in future studies about the role of Helicobacter pylori in upper gastro-intestinal pathology.