Background-Endothelial dysfunction may play a pathophysiological role in the development of atherosclerosis in subjects with type 1 diabetes. We examined whether alterations in vascular endothelial function exist in children with type 1 diabetes and tested the hypothesis that endothelial dysfunction is associated with early structural atherosclerotic vascular changes in these children.

MATER IALS AND METHODScourse of diarrh ea. Maln utrition has been report ed to increase the absorption of potentially harmful antigens (2) and to impai r imm une responses (3). A poor nutrition al state may thu s increase the risk of protracted diarrh ea as well as enhance susceptibility to other infectio ns and to gastroi ntestinal allergy. The nutritio nal state of even well-no urished infants deteriorat es rapidly during diarrhea, either because of loss of appetite, deliberate withholding of oral feeds, or partial malabsorption caused by viral invasio n ofenterocytes (4).Rapid reintrodu ction of oral feedings after rehydration has been advocated to coun terac t the pote nti al hazards related to fasting during diarrhea (5). We have previously shown that rapid refeeding results in earlier cessatio n of diarrhea in well-nourished children; also, cow milk produ cts are tolerated (6). A furt her shortening of diarrhea resulted from administratio n of hu man Lactobacillus stra in (Lactobacillus GG, Gefilac, Valio Finni sh Co-operative Dairies' Associatio n, Helsinki, Finland ) together with the rapid refeeding schedule (7). The mechanisms behind such a favorable outc ome remain poorly understood. Th e effect of nutritional therapy may be immunologically med iated and may prove important in eradicating enteric infections in the imm unocompromised host.The objective of the present study was to evaluate the effect of L actobacillus GG on the intestinal immune response triggered by rotavirus infection in well-nourished children. For th is pu rpose, we used the ELISPOT assay, which measures ISC and sASC amo ng circulating lymphocytes. T hese cells are arrested du ring their maturation cycle in peripheral blood, giving indirect evidence of gut local im m une respo nse (8-10).Patients. Forty-four well-no urished children (33.4% female), between 7 and 37 mo of age, were enro lled in the present study. Th ey were admitted for acute gastroen teritis of less than 7 d du ration at the Departm ent of Pediatrics, Ta mpere U niversity Hospital, during a rotavirus epidemic .Informed consent was obtaine d from the patients' pare nts, and the protocol was approved by the hospital's Committee on Ethical Practice.Ma nagement and samples. U pon ad mission, the children were weighed and clinically examin ed. The severity of dehydration (%) was estimated. Th e children were treated according to sta ndard practice: oral rehyd ration was accom plished in 6 h with a , solution containing Na" 60 mmo l/ L and glucose 144 mm ol/L (Osmosal Novum, Leiras, Turku , Finland) given at twice the estimated fluid loss with a minimum of 30 mL/kg body weight. Th e patients were weighed daily. Th e attending nurs es followed the quality (characterized as watery, loose, or solid) and number of stools and vomitus. The du ration of diarrh ea was counted 14 1

Laparoscopic Nissen fundoplication is a safe and feasible procedure. Complications are few and functional results are good if not better than those of conventional open surgery.

We sought a relationship between total and cow's milk-specific IgA levels in colostrum and human milk and subsequent development of cow's milk allergy (CMA) in the breast-fed infant. The study included 87 nursing mothers and their infants (age, 2 d to 7 mo), followed prospectively up to 1 y. At 1 y, 48 mothers (69% with an atopic constitution) had an infant with CMA, verified by clinical cow's milk challenge, eight (38% with an atopic constitution) had a baby who had had protracted infantile colic but no CMA (disease control group), and 31 (23% with an atopic constitution) had a healthy infant. Total breast-milk IgA was measured by radial immunodiffusion, and IgA antibodies to cow's milk were measured by ELISA during the breast-feeding period. The levels of total and cow's milk-specific IgA antibodies in colostrum and human milk were significantly lower in the mothers whose baby later developed CMA [estimated third day value, 0.38 g/L (95% confidence interval, 0. 24-0.82)] than in the ones whose infant remained healthy or had had infantile colic but not CMA [0.82 g/L (95% confidence interval, 0. 99-1.51); p < 0.05]. The infants developed CMA significantly more often if the concentration of total IgA antibodies in milk was <0.25 g/L, when measured between 6 d and 4 wk postpartum [sensitivity, 0. 55; specificity, 0.92; odds ratio, 14.7 (95% confidence interval, 3. 1-70.2); p < 0.001]. The levels of cow's milk-specific IgA positively correlated with the levels of total IgA but not with the development of CMA in the infant. The levels of total or cow's milk-specific IgA did not correlate with maternal atopy. IgA antibodies in colostrum and human milk may prevent antigen entry at the intestinal surface of the breast-fed infant. A low IgA content in human milk may lead to defective exclusion of food antigens and thus predispose an offspring to develop food allergies.

Most of the minor bile duct injuries, including cystic duct leaks and bile duct strictures, are well treatable with endoscopic techniques, whereas most of the major injuries require operative treatment, which at optimal circumstances gives good results.

Traumatic perforations and anastomotic leaks can be treated effectively with covered SEMS together with adequate drainage of the thoracic cavity even in cases of severely ill patients with inveterate esophageal perforations and leaks.

Background and Aims: Certain appearances of the major duodenal papilla have been claimed to make cannulation more difficult during ERCP. This study uses a validated classification of the endoscopic appearance of the major duodenal papilla to determine if certain types of papilla predisposes to difficult cannulation. Methods: Patients, with a naïve papilla, scheduled for ERCP, were included. The papilla was classified into one of 4 papilla types before cannulation started. Time to successful bile duct cannulation, attempts and number of pancreatic duct passages were recorded. Difficult cannulation was defined as, after 5 minutes, 5 attempts, or 2 pancreatic guide-wire passages. Results: One thousand four hundred one patients were included from 9 different centers in the Nordic countries. The overall frequency of difficult cannulation was 42% (95% CI, 39%-44%). Type 2, small papilla, (52%; 95% CI, 45%-59%) and Type 3 protruding or pendulous papilla (48%; 95% CI, 42%-53%) were more frequently difficult to cannulate compared with Type 1, regular papilla (36%; 95% CI, 33%-40%, both p<0.001). If an inexperienced endoscopist started cannulation, the frequency of failed cannulation increased from 1.9% to 6.3% (p<0.0001), even though they were replaced by a senior endoscopist after 5 minutes. Conclusion: The endoscopic appearance of the major duodenal papilla influences bile duct cannulation. Small, Type 2, and protruding or pendulous Type 3 papillae are more frequently

We conclude that in children with atopic eczema food allergy is associated with intestinal inflammation indicating that more general immunologic disturbances than previously thought take place in these patients. We further suggest that faecal eosinophil cationic protein, tumour necrosis factor-alpha and alpha-1 antitrypsin distinctly indicate various reaction types of food allergy. Parallel testing with eosinophil cationic protein and tumour necrosis factor-alpha may significantly enhance the accuracy in diagnosis of food allergy in patients with atopic eczema.