This study shows that at least in the short term following the creation of a dialysis a-v access, a mild state of volume overload develops, which is offset by the ¿unloading' effect of the decreased peripheral vascular resistance; the latter is probably mediated by secretion of ANP in response to atrial stretching.

The effect of epidermal growth factor (EGF) on the ontogeny of the gastrointestinal tract was examined in New Zealand White rabbits. EGF, 40 micrograms X kg-1 X day-1, was administered to suckling animals from 3-18 days of age either intraperitoneally or orogastrically. Controls received saline. Animals were killed at 17-18 days of age. Body weight and wet weight of stomach, pancreas, and 10-cm segments of proximal, mid, and distal small intestine were measured. The total pancreas was homogenized for determination of protein, DNA, and amylase, and the intestinal mucosa was scraped, weighed, and homogenized for estimation of protein, DNA, sucrase, and lactase. While body weights were similar wet weight of stomach and pancreas were increased by intraperitoneal and orogastric EGF. Small intestinal wet weights were increased in all segments by intraperitoneal but not orogastric EGF, and both routes significantly increased mucosal DNA in the distal segment. EGF administered orogastrically induced precocious maturation of intestinal brush-border disaccharidase activities but had no effect on pancreatic amylase, whereas EGF administered intraperitoneally induced precocious maturation of pancreatic amylase but had no effect on brush-border disaccharidase activities. These findings suggest that both systemic and oral EGF play a role in regulating growth and postnatal maturation of the gastrointestinal tract.

The results suggest that serum transferrin receptor is a useful parameter for the diagnosis of iron deficiency in inflammatory bowel disease, in particular, the transferrin receptor/ferritin ratio with a cut-off level > or = 350.

Hepatic artery thrombosis (HAT) is a devastating complication that may occur after orthotopic liver transplantation (OLT). A higher incidence has been reported in children. Salvage of the graft by thrombectomy has been suggested as an alternative to re-transplantation. In this study we report the outcome of three children who underwent thrombectomy for HAT. Between January 1992 and June 1998, 14 children (< 17 yrs of age) underwent liver transplantation. Three developed HAT (one a whole-liver graft recipient, age 17; two living-related graft recipients, ages 4 and 4.5 yr). In the first patient, thrombosis of the hepatic artery was associated with scattered areas of parenchymal necrosis on computed tomography. In the two living-related patients, HAT was found incidentally during re-exploration for bleeding (day 2 and day 10). Thrombectomy was performed in all three patients. At 18-24 months after thrombectomy, all three children had normal graft function. In the first patient, complete regeneration of the liver has been documented by computed tomography and a late asymptomatic recurrent thrombosis is suggested by absence of arterial flow on Doppler examination. The hepatic artery is patent in the two living-related recipients. One of these living-related recipients developed ischemic bile duct stricture and underwent successful percutaneous balloon dilatation. We conclude that long-term normal graft function can be achieved by thrombectomy in pediatric liver recipients with HAT, even in the presence of limited parenchymal damage.

Celiac disease was diagnosed by jejunal biopsy and response to gluten elimination in 11 of 23 children with short stature referred after negative endocrine evaluation. The mean age of the group was 11 years, with a range of 5-16. All had been followed for a mean of 2.5 years at a large pediatric endocrine clinic for the evaluation of growth retardation. Bone age retardation of more than 25 percent of the chronologic age was found in all children. Microcytic anemia and past history of gastrointestinal problems were typical of the celiac group but were not documented in the nonceliac patients. Stool fat excretion was a specific but insensitive test, while the 1-hour blood xylose test was of no value in differentiating between the two groups. Close cooperation between pediatric endocrinology and gastroenterology clinics may be fruitful in the identification of celiac patients, especially in a group of older children with short stature, bone age retardation, and microcytic anemia.