sumMARY Plasma alkaline phosphatase activity was measured in 349 infants aged between 5 and 10 days to establish a normal range for different gestational ages. Significant differences were observed between term and preterm infants, the highest values being associated with the shortest lengths of gestation. Plasma calcium, phosphate, and alkaline phosphatase activity were measured sequentially in 51 preterm infants < 1500 g at birth. A significant correlation was found between raised plasma alkaline phosphatase activity and radiological changes of osteoporosis, metaphyseal change, and periosteal reaction. Plasma alkaline phosphatase appears to be of value in screening for and monitoring rickets of prematurity.
A 10 year old boy with Proteus syndrome presented with a pericardial eVusion of unknown aetiology. Immunological investigation revealed low serum IgG and IgA, accompanied by low levels of specific antibodies to pneumococcal and haemophilus type B polysaccharides. Circulating lymphocyte surface marker profile revealed T and B cell lymphopenia. This is the first report of hypogammaglobulinaemia occurring in the Proteus syndrome. (Arch Dis Child 2000;82:234-235)
Concentrations of conjugated cholate, chenodeoxycholate, direct bilirubin, and alanine aminotransferase (ALT, EC 2.6.1.2) were measured in plasma of 122 low-birthweight infants receiving parenteral nutrition. Eighteen (15%) of them developed hepatic dysfunction. We observed two distinct biochemical patterns in these infants. In the Type A pattern (12 infants), concentrations of direct-reading bilirubin and bile salts increased with no change in ALT activity. In the Type B pattern (six infants), increases in the concentrations of bile salt and direct bilirubin were followed by increases in ALT activity. Hepatic dysfunction persisted significantly longer in infants who developed the Type B pattern. The two patterns did not differ significantly in the times at which values for bile salts or direct bilirubin in plasma became abnormal or became normal at resolution, nor did maximal concentrations of bile salts in plasma differ significantly. Maximal concentrations of direct bilirubin were higher in the Type B infants. We conclude that, in such infants, measurement of bile-salt concentrations in plasma offers no advantages for detecting hepatic dysfunction over the more conventional measurement of direct bilirubin in plasma.
myocardial infarction so that any arrhythmia that developed could be treated promptly. However, there is evidence that hospital care may actually cause some of the arrhythmias that then have to be treated. More than 20 years ago Dr Klaus Jarvinen' observed that a disproportionate number of patients dying in hospital after acute myocardial infarction did so during or shortly after ward rounds. That interaction with hospitals and staff can significantly affect a patient's heart rate and rhythm is also well documented.2 Although no one would suggest that there is no place for specialised coronary care units it is tempting to speculate that they have to be so well equipped and expertly staffed to compensate for the arrhythmias precipitated by the fear and isolation experienced by a patient in hospital. A study comparing the incidence of arrhythmias after myocardial infarction at home and in hospital would be most interesting.
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