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Thirty-eight children with chronic active hepatitis are reported. Their mode of presentation was usually indistinguishable from acute viral hepatitis (63%). Extra hepatic manifestations were more common in those patients with an insidious onset. The twenty-eight patients tested for hepatitis B antigen (HB Ag) were all negative and SGOT values were higher (mean 1000 i.u./l) than those reported in adult patients with chronic active hepatitis. Thirty-three patients had marked elevation of serum gammaglobulin (mean 3·78 g/100 ml) and 34% had positive LE cells. All patients had histologic features of ‘aggressive’ hepatitis; in addition five biopsies also showed areas of submassive hepatic necrosis. The initial response to corticosteroid was excellent in all but three patients. To date drug therapy has been suspended in fifteen patients for periods of 3 months to 4 years and 7 months. There have been eight deaths. Three with hepatic insufficiency and two with sepsis. Three others have subsequently died following orthotopic liver transplantation. [ABSTRACT FROM PUBLISHER]

Lactobezoar is a foreign body produced in the gastrointestinal tract by the presence and accumulation of undigested milk curds. It is seen most commonly in low-birth-weight, premature infants fed with 24-calorie formulas. Conventional therapy includes withholding feedings, repeated gastric lavage, and maintenance of nutrition and hydration by the parenteral route. Most cases respond to this regimen within 48 to 72 hours. We present a case of gastric lactobezoar in a premature, small for gestational age infant who was fed a 24-calorie formula but failed to respond to conventional therapy for more than a week. Historical background and pathophysiology of lactobezoar are discussed.

Thirty children less than 15 years of age with Crohn's disease are reported. The mean age of onset was nine years and five months. Delay in diagnosis may stem from the varying modes of presentation. The mean delay in diagnosis was two years. Chronic diarrhea and/or recurrent abdominal pain associated with extraintestinal manifestations, particularly abnormalities of growth and development suggests the possibility of Crohn's disease in the pediatric age group. Involvement of the terminal ileum occurred in 29 of the 30 patients. In addition, colonic disease occurred in 13 and jejunal involvement in one. Four patients presented with an acute onset of their disease. A favorable response to either medical or surgical therapy occurred in all four. Twenty-six patients had an insidious onset and tended to have a chronic course despite either medical and/or surgical therapy. Thirteen patients had an intestinal resection, with recurrence occurring in three from 1-4 years postoperatively. To date there has been one death.

The course and outcome of pregnancy in two adolescents with chronic active hepatitis is described. Pregnancy was uneventful in both patients apart from mild biochemical deterioration in one patient. Both infants are entirely normal. One mother died 4 1/2 months after delivery from primary pulmonary hypertension, an extrahepatic manifestation of her chronic active hepatitis. The second patient is asymptomatic but has evidence of ongoing liver disease 26 months postdelivery.

Acute hydrops of the gallbladder is described in four patients who had mucocutaneous lymph node syndrome. Diagnosis was readily made with gray-scale ultrasound, and the patients were followed with this technique. The gallbladder returned to normal size in all of the patients within 15 days, and none of the patients needed surgery. The role of surgery in acute hydrops of the gallbladder is for the complications of the hydrops and not for distention alone.

A case of vasoactive intestinal polypeptide secreting ganglioneuroma associated with watery diarrhea and hypokalemia is presented. Diagnosis was delayed due to the presence of two parasitic infestations. After surgical removal of the tumor, the diarrhea resolved.

The anatomic congenital anomaly pancreas divisum has recently been implicated as a cause of acute pancreatitis. The associated stenosis of the minor papilla has been postulated to cause pancreatitis by producing a relative obstruction to the high volumes of dorsal pancreatic secretion. We present a 10-year-old boy with acute pancreatitis associated with pancreas divisum to illustrate this as a cause of pancreatitis in childhood.

We report a retrospective review of peptic ulcer disease (PUD) in children seen at Children's Hospital of Michigan, over 10 years (1971-1980). Of the 61 included, 31 had primary ulcers and 30 had stress ulcers. The diagnosis was made by either barium meal or endoscopy, at surgery, or at autopsy. Stress ulcers were commoner in children less than 4 years of age and were precipitated by various conditions leading to shock. The majority of these patients required surgery for perforation or bleeding. Primary ulcers were more common in children older than 4 years. The most common presenting symptoms in this group were abdominal pain and gastrointestinal bleeding. The majority of patients with primary PUD received medical therapy in the form of antacids and/or cimetidine. In one-third of these patients, surgery was necessary for complications such as intractable pain, perforation, or massive recurrent hemorrhage.