ee ee | Exadmenes. de Comprensi6n de Lectura en Inglés: Medicina RE libro de practica Leticia Martineck Carmen Tobia Universidad Nocicnal Auténoma de México Centro de Ensefiaraa de Lenguas Extranjerax DomesExamenes de Comprensién de Lectura en Inglés: Medicina libre de practica Loticia Martineck*Carman Toblo Univernidad! Nacional Auténoma de Méxleo Contro da Enseranza co Longuas Extranjeras Meteo 1005.resolver los examenes? 08 do verdadero/talno Effect of Inclusion of Beans in a Mixed Diet for the ‘Treatment of Peruvian Children with Acute Watery Diarrhoea ‘The Grying of infants with Colic: A controlled Empirical Description Tolovision Viewing and Pediatric Hypercholestersiemia Migraine, Glinical Features: Genetics and Epidemology Hypervitaminosis D Associated with Drinking Mik | Hypervitaminosis D Associated with Drinking Milk Methods Bias and ‘Overcall' in interpreting Cheat Radiographs in Young Febrie Children Diabetic Gastraparesis Due to Postprandial Antral Hipomatilty in Childhood {I Diabetic Gastroparesia Due to Postprandial Antral Hipomotility in Childhood Migraine: Theorles of Pathogenesis ‘Vitamin A and Pregnancy Medical Treatment of Acute ischaemic Stroke Primary Prevention of Stroke: 20 22 Ba 26 2B 30 a2 a4 36 38 40 42 44Grass Pollan and Asthma II Calcum Supplementation to Prevent Hypartansive Disorders of Pregnancy | Primary Prevention of Stroke, Risk Factors for Stroke. (Causes, risk factors, and variations in occurrence) Ill Rigk Factors for Stroke, Individual Risk Factors | Prediction of Mortality in Patients with Cystic Fibrosis Pathological Assessment of Mediastinal Lymph Nodesin Lung Cancer: Implications for Non-invasive Mediastinal Staging Examenes de opelén multiple Treatment of Alcohol Addiction Social Phobia Japan Explores the Boundary Between Food and Medicine Genes, Patents and Sex Determination Sleep Panic Attacks: New Clinical Findings and Theoretical Implications Pink and Purple Urine Prozac Congenital Hypothyroldsm ‘Contributions to the Treatment of Dermatologic Manifestations of Lyme Borreliosis 46 $2 56 $8 63 7 15 80 85 69INTRODUCCION Este libro astd citigido a estudiantes de Medicina, de cualquier nivel, que deban fresentar un examen de comprensin de lectura én inglés con textos de su area de estudios, Este material tlene un doble propésite; dar la oportunidad da practicar [a solucién de exérnenes @ los alumnos que lean fiuidamente, y propercionaries a quienes carecen de los conocimientos suficientes para leer sin dificultad, un spoyo pars alcanzar un mejor dominio de este idioma extranjero. Los exdmenes aqul incluidos presentan las mismas caracteristicas que los utlizados 8n el Centro de Ensenanza de Lenguas Extranjeras con los estuciantes arriba mencionades, Los materiales de lectura proceden de libros de texto, enciclopedias, revistas y peridcicos da la especialidad, y han sido reproducidos sin alteraciones de lenguaje, de mado tal que al interesacio tenga contacto con textos paralelos a los que su formacion y elerciclo protesionates le exigen leer Las preguntas incluidas son, igualmante, del tipo empleado on el CELE: verdadero/talso, opcién mcltiple y el formato llamado dla canava, en el cual se presenta un pasaje dé lectura del que se Nan omitido palabras, Todos estos ‘exdmenes buscan medi la capacidad del candidate para captar la idea general del articulo, resefa 9 fragmento de libro de texto al mismo tiempo que poner 5 prueba su habllidad para ir siguiende paso a paso, de manera minuciosa y precisa, lo expueste por el autor. Ellibre ha sido elaborado de manara tal que ge pueda trabajar con él sin ayuda del profesor. Se han incluido instrucciones sobre cémo resolvar los examanes, explicacionas y claves de respuesta para qué él alumno restielva por si misrno las pruebas, amplie sus conocrientoas de gramética o vocabulario y evalde su propia habilidad para leer. Asimismo, o| material contiena an sus paginas finales un glosario minimo de términos frecuentes en la especialidad. Leticia Martine, Carmea TobieINTRODUCCION Este libro astd citigido a estudiantes de Medicina, de cualquier nivel, que deban fresentar un examen de comprensin de lectura én inglés con textos de su area de estudios, Este material tlene un doble propésite; dar la oportunidad da practicar [a solucién de exérnenes @ los alumnos que lean fiuidamente, y propercionaries a quienes carecen de los conocimientos suficientes para leer sin dificultad, un spoyo pars alcanzar un mejor dominio de este idioma extranjero. Los exdmenes aqul incluidos presentan las mismas caracteristicas que los utlizados 8n el Centro de Ensenanza de Lenguas Extranjeras con los estuciantes arriba mencionades, Los materiales de lectura proceden de libros de texto, enciclopedias, revistas y peridcicos da la especialidad, y han sido reproducidos sin alteraciones de lenguaje, de mado tal que al interesacio tenga contacto con textos paralelos a los que su formacion y elerciclo protesionates le exigen leer Las preguntas incluidas son, igualmante, del tipo empleado on el CELE: verdadero/talso, opcién mcltiple y el formato llamado dla canava, en el cual se presenta un pasaje dé lectura del que se Nan omitido palabras, Todos estos ‘exdmenes buscan medi la capacidad del candidate para captar la idea general del articulo, resefa 9 fragmento de libro de texto al mismo tiempo que poner 5 prueba su habllidad para ir siguiende paso a paso, de manera minuciosa y precisa, lo expueste por el autor. Ellibre ha sido elaborado de manara tal que ge pueda trabajar con él sin ayuda del profesor. Se han incluido instrucciones sobre cémo resolvar los examanes, explicacionas y claves de respuesta para qué él alumno restielva por si misrno las pruebas, amplie sus conocrientoas de gramética o vocabulario y evalde su propia habilidad para leer. Asimismo, o| material contiena an sus paginas finales un glosario minimo de términos frecuentes en la especialidad. Leticia Martine, Carmea TobieéCémo resolver los examenes? Un primer paso es elegir una de las siguientes opciones: * un conjunte de exdmenes ~75 reactivos- de respuesta de verdadero/falso, de los que forman el primar grupo cel libro + dos exdmenes, los que interesen al lector, de opcidn multiple, de! segundo grupo * unexamen de opcion multiple y uno del tercer grupo, del tipo de prueba en 61 cual se han omitido palabras del texto original (Si vas a presentar el examen de comprensidn de lectura de textos de medicina nel GELE, te interesard saber que ese examen estd formado por cualquiera da las tres combinacionas expuestas arriba.) En segundo lugar. responde fa combinacién elegida sin consultar al diecionaria y 60 un periode que no exceda los 90 minutos, * para entender al material en inglés, apoyate en tus conacimientos del tama * para elogir respuesta, vuelve siempre al texto y localiza la palabra 6 Palabras relacionadas con la pregunta; el ne valver al texto produce muchos errores en la eleacion * Una vez que te hayas decicide por una respuesta, continda; na insistas en trabajar excesivamente un reactive porque esto produce confusion Un tercer paso as revisar lag respuestas en las claves al final del lisro, Calcula el porcentaje total de aclertos consequicios y considera que el resultado minima Satisfactorio no debe quedar por debaja de un 70% de respuestas correctas, Finalmente, si no has logrado el porcentaye requerida de aciertos asi lees con ‘excesiva lentitud y rebasas log $0 minutos al contestar, puede deberse a maneras incorrectas de leer o a conocimientos insuliciantas del idioma, Seguidamente encantrards algunas recomendaciones para enfrentar los dos problemas. 322Como leer mejor? La comprensién consiste fundamentalmente en capter las ideas, datos, hechos, opiniones, intenciones, ete, axpuestas por el autor; #8 esencial, por lo tanto, no olvidar e! propdsite cde entender lo dicho por al texto y no considerar que la lectura significa tradueir trabajosamente cada una de las palabras, Gran parte de lo expuesto por el autor se puede entender aun euando no se conozca cata element escrito, Un recurso que facilita la comprension de un texte 68 efectuar una primera lectura rApida, superficial, con el fin de fermarge una idea ganeral dal contenide, Antes de entrar en una lectura detallada, conviene tamblén fijarse en aquellos: términos que sé repitan y que parezcan importantes -si no los conoces, buscarlos en ¢! diccionario-, analzar titulo, subtitulos ¢ llustraciones -cuando: estos dos ditimos aparécen- para con base en ellos anticipar el contenido de la lectura, = Desde luego, para mejorar ja capacidad de lectura, as necesario practicar Aparte de ejercitarte con este libro, es importante que busques en revistas, periddicos o libros oportunidades de leer en inglés. éQué hacer si no se tienen conocimientos suficientes del inglés? Sino conoces el vacabulario basico del inglés, tendris que usar el diccionario Inglés-esperiol para contestar los examenes; sin embargo, existen algunas maneras de enfrantar este problema sin recurrir continuarmente a este apoyo. Algunas de ellas son: * aprender a saltarse palabras desconocidas que no son indispensables para la comprensién + feconocer las palabras que se parecen al espariol y tratar de inferir su significado; por ej. faver: flebre Existen, sin embargo, algunas palabras engafosas que, pareciéndose a otras del esparial, tianen un significado diatinto al de nuestro idioma. Por 9}. injury: dare, physician: médica (generalmente confundida con “fisico”), realize: darse cuenta (no "realizar’), actually: en realidad (no "actualmente’),14 * tratar de adivinar vocabulario por su contexto; por e),, en a frase “that the drug induced violent and suicidal behaviour", fas palabras que van antes de "behaviour" (comportamienta) nos dan pistas sobre el posible significade de ésta come algo que llene que ver con los alectos de una droga y con suicidlio Ademés de las estrategias arriba descritas, para poder leer fluidamente es necesario conocer el vacabulario esencial, Por media det trabajo can las lecturas en las siguientes paginas puecies ir adquirendo este vecabulario, Algunas de las formas en que puedes mejorar la retencion son: > aubrayar las palabras que consideres importantes, que se repiten con frecuencia o qua, sencillamente, te llamnan ia atencion * en hoja aparte it haciendo una lista de los vocablos que aparecen continuamente y que en tu opinion deben ser aprendidas; este glosario personal es, al mismo tlompo, un diccionario manuabla para regelver examenes, * teleer los materiales en inglés uno o dos dias después de haber trabajado con ellos; esto ayuda a recordar elementos nuevos de un idioma extranjero * muchas palabras son susceptibles de visualizarse mentalmenta; la técnica de acompariar la palabra nueva con una imagen mental de su significado facilita of muchos eases el recorciarla Una fuente de errores en la comprension es el hacho da que las palabras tishen comanmente mas de un sentido: //ke quiere decir "gustar", pero también significa "como". Si recurres al diccionario para aclarar dudas, no te dotengas en el primer equivalente en espafiol, Lee varios significados y gscoge de antre ellos ¢l que te parezca mas ldgico en el contexte de la palabra desconocida. Algunos obstécuies que encuentra 8! lector da habla espirola pertenscen al ‘campo de Ia gramatica inglesa, Uno de los mas comunes se¢ refiere a las frases con un orden distinto al de la langua materna. Par ejemplo, urinary tract, therapeutic diets 0 language processing areas tienen un orden Inverse 4 8U5 equivalentes en nuestra idioma: “tracto urinario", “dietas terapéuticas”. “areas de procegamiento del lenguaje", Cuando encuantres una frase cuyo yoeabularia entiendes pero a la que no puedes encontrar senticlo, considera la Posidilidad de que se trate de uno de estos agrupamientos en que uno oO varios adjativos anteceden al sustantive, Localiza al sustantivo principal y jee hacia atrésLos materiales acaddémicos suelen contener abraviaturas como /.8. (que significa “es decir") 0 e.g. ("por ejemplo"). Muchos diccionarios de ingiés-espanal incluyen al principio o final listas de abreviaturas y ‘sus significados. Algunas palabras tienen un plural itragular, entre alias: datum (cuyo plural es. dala), nesis/theses, dlagnosis/diagnoses, o spectrum/spactra,Examenes de verdadero/falso EFFECT OF INCLUSION OF BEANS IN A MIXED DIET FOR THE TREATMENT OF PERUVIAN CHILDREN WITH ACUTE WATERY DIARRHEA SS TE TEL instueciones: Lea euidadosamente ol siguiente artculo 8 indica si eada unc de (es enunclados que /e siguen es verdadero (V) 6 false (F) sequn jo dicho en el texto, A double-masked clinical trial was conducted to assess tho effects of Inclusion of baans in a mixed diet for young Peruvian children with acute diarrhea. Dietary treatmant consisted of either rice, beans, and vagetabie oll (group RB, = 25) oF rice, soy-protein isolate, corn 5: syrup solids, and vegetable oll (group RS, n= 21), each given in arounts up to 150 kcal/kg bodly waight per day immediately following rehydration therapy. The groups were generally similar at the time of admission, and there were no differences in the rates of treatment fallure (896 in group RB,14% in groups RS; P=.65). Mean stool outputs 10 were 8348(SD)g/kg body weight in group AB and 7143 (SD) gik body waight in group RS on day 1, and these outputs consistently ranged from 25% to 40% greater in group AB than in group AS (P = .058), By contrast, the median duration of liquid stool excretion was substantially less in group AB than in group AS (60 vs 121 hours, P=.01), The 6 fractional absorption of carbohydrate, fat, and total energy was significantly greater by children In groups AS, but there were no differences in net apparent absorption of these nutrients because the children in group RB consumed significantly more of their assigned diet. Children in group RS gained significantly more weight during the 20 whole period of observation (184g vs 1g, P= .047), but these differences could be entirely explained by the weight (and presumably fluid) changes on day 1, Thera ware no consistent differences by dietary group in any of the other anthropometric indicators. It is ‘concluded that despite moderate increases in stool output, the amount 25 of beans offered in this study can be safely incorporated in a mixed diet for children with mild of moclerately severe acute watery diarrhea.1. Tho study was dowigned to evaluate the elfect of beans an daly diet or children {vail undorcovelaped countries 2. Peruvian children sutter acute diarrhina because thelr malty nutritional yource Is boars, 4) The dietary treatmont of young Peruvian etielren who muttered from acute diarrhea ineluded rice, branis and vegetable ail, 4. The diotary treatment of young Peruvian chiciren whe suslered from acute diarrhoa Included ree. soy-protein lwolnto, corn syrup sallda, and vagetublo all 4. Two dietary trentmants were compared 6, Children with dehydratation cid not include solids in their diotary treatment *. Tho groups had statistical nlgnifieance eiHloreneed ih tha rates of troatmont falure 8. The studied aroups Included only ehiliren who had mild debydratation at the tine: of admission. 8. The median dumtion of liquid stool excretion was greater in group AS that i group RB, 10. Thoro Wore sinwll elfferenoes in not apparent absamptien of earbotydrate and fat between the two Grunt. 11, Group AB aie less than group PS 12. Differences in weight during tne whoto porled of observation wore due to change In diotary treatment. 19, Boans can increaye stool output 14, Boans can be included in-a mise! diol for children with mic diarrhea, but not in a lot for chilcran with sovero diarrhoa. 14, Thore worm significant difforoncos In the amount of stool Output betwean the Iwo groups VF ve vr ve ve ve vF VF ve VF VF ve VF ve 18THE CRYING OF INFANTS WITH COLIC: A CONTROLLED EMPIRICAL DESCRIPTION To obtain a controlled empirical daseription of some of the Measurable clinical features of colic In a naturalistle context, 8 infants whosa mother considered arying a problem ("colle") ane 38 paif-Matchad control infants ware observed and videotapad at home 10 -} minutes before and after an avening feed, The parents kept a eiary of infant behaviors (Including crying and fussing) for 7 days following the visit, Following Wessel ef ai, (Peciatries. 1954:14:421- 434), each "colic" Infant was classified according to the number of days per week that srying and fussing duration was greater than 3hid, The distribution of 10 infants with colic suggested that there were two subgroups; Wessels colle infants, with 3 days or more per week of more than 3 hours of erying and fussing per day, and non-Wessel's cofic and contra! infants, with fewer such days, Maternal measures of total daily crying/tussing duration, erying/ussing bout length, and infant temperament and 18 objective analyses of facial activity showed # consistent pattern of differences in which Wessel's colic infants differed fram bom non-Wessel's colic and control intants, wha In turn did not differ from each other. Both colle groups differed from control infants only in the perception of postieed cries as being mare "sick sounding”. The results 20 imply that the complaint of colic reprasents two (ot more) Groups and that there may be meaningfully distinet colle syneromes. Thoy also provide the first Independent empirical support for Wessel ane colleagues'clinical distinction between "ussy” and “contented” babies,20 a 22, 2, 24. 25. 26. 27, 28. 29. | The objective of the studly win to prove a theory on regular features of gale in small babiow Subjocts wore @gilse ifthe crying of the infants was Hoon Aa & problom, 34 infants andl thelr mothers Wen moasured Ih a haturallstie context 34 Infants with crying problems were part of the control group. 76 Infants in the control group wore vileotaped. Tho infants wore videotaped whi being foe Babiow with crying prablenn wore vilootaped for the cantralled empirical description Children ware given a diary with written inutrietiony to be corpleted in the following ? days, ‘The contro! group conalited of childferi who cried for more than three hours 3 oF more days a wook, Non-Weisol’s colic infants cried ly than Woasel'a calle infants, Crying, ning duration, tempormmunt, ancl facial aotivily ware measured by the children's mothers. ‘The two colle groups did not diffor rom each other. The poatfood eles duration of the Oonitrok group yes grote than hel The crying ol two groups sourced morw painful than the thie group, There ind meaningful clinical cintinetion botwoon fussy and contented babies with colic nyncromas VE VF ve VF VF VE ve VF VF vF ve VF VF ve ve aTELEVISION VIEWING AND PEDIATRIC HYPERCHOLESTEROLEMIA Cholesterol screening for children is recommended currently only for those with a family history of premature coronary heart disease or hyperlipidemia. The authors report an a pediatric-office-based cholesterol screening program where the predictive values of family 5 history indicators were evaluated along with reported television viewing, physical activity, and dietary habits |n 1081 childran (aged 2 to 20 years mean 7.4. 3.6(SD) years). Eight percent of these childran had a total cholesterol value of 200 mg/dl or higher; 53% of such children reported watching 2 of more hours of television daily compared with 34% of 10 children with lower cholesterol levels. Multivariate analyses revealed that excessive television viewing was the strongest predictor for a child to have a cholesterol value of 200 mg/dl or higher, with relative risks of 2.2 for 2 to 4 hours of television viewing per day (P.01) and 4.8 for children watching more than 4 hours/day, when compared to thoge watching 15 loss than 2 hours/day (P.01), In contrast, a positive family history of high cholesterol level was only modestly associated with increased prababsity of having a high cholesterol level (relative risk = 1.6, P.05), and a history of premature myocarcial infarction in @ parent or grandparent was not associated with a child's cholesterol level, Excessive television viewing 20 was found to be associated with certain dietary and physical activity habits and may prove to be a useful, global marker for several life-style factors predisposing children ta hypercholesterolemia, 2221. Its bollavod! nawadlays thar thord isa rhik Of igh ehotostorot lovols In ehilelron with a family. history of high cholosterol 82, Currently screening for high cholesterol levels is recommended for all kincl of children, 40, Atamily hlatary of oxeoss of lipemic substances In the blood makes doctors recommend cholesterol screening, 84, Children with olevated cholestorol! Valuos are missiod when sereoning ke goniorally limited te these with poshive tarnily history Indieatoes, 45, Researchers evaluated not only the predictive values of family history but other markars a well 36, 1081 childron evaluated! tholr physleal activity, 37. Children who did nat wateh TV for two hour every day had olevated blood cholesterol levels. 3B, Beste tolevision viewing haw beer linked ta unhealthy dietary habits ane ity. 9, Leas TV watching la correlated with lower chotesteral level 40, Family history of cholesterol Is strongly associated with the probability of having a high cholesterol favel, 41, Premature carding infarct in grandparents and parents is related te the ehilel's high cholosteral level, 42, Watching too much television can be consictered a gocd marker for posalble high cholosteral level 43, Life style seems 10 be rolatod 10 powitive cholesterol 44, Mypercholesterolemia in childhood in very common. 45. A prodiipouition to hypercholsterolemia may be tound in children watching too much television, VF ve ve VF VF ve ve vF VF VF vr vF ve ve VFMIGRAINE Clinical Features Premonitory symptoms ara subtle, develop slowly, alter mad behaviour, and gut activity, jast saveral Nours, and implicate the frontal lobes and Hypethalernus, The classic aura is a visual disturbance that oritts across the visual field, almost certainly arising in the occipital 5 cortex, oF a NuMbness that ascends trem the fingertips to the shoulder in 8-10 min, probably originating in the sensory cortex. The next phase, the headache takes 30 min to 3h te reach maximum intensity, As it Increases, itis joined by a range of features -navsea, pallor, photophobia, phonophobia, csmaphobia, tiredness, irritability, impaired 10 concentration, dysphi thet implicate the whole brain, particularly the hypothalamus and cortex, The mast commen way in which attacks resolve is through sleep, although particularly in children vomiting can end headache quickly: s/eep and vomiting are neurally mediated, probably via the hypathalarmus and brainstem. The posteromal 15 hangover phase of migraine has only lately been studied, although foperted by 90% of migralnous adults. With one exception, the symptams and signs of migraine develop slowly, The exception Is the aura; but even then the rate of spread ig at least a hundred times slower than that sean in attacks of vascular or 20 epileptic origin. 2a48. Los sintoman anteriores w li apariciN mlema eo lv migraha so prowantin poca W poea, 47 Alqunos aintamaa se deaarrollan rio repante alterando el humor del paclente ai, No hay trastumog en la aotiviad cle inteating, 49, La alteracién de la coneluets punde sor vintoma de la migrana. E! aura clislon puoce ser ii trustomo vista quo ao origina on ta eorteza occiptal 61, La migra cauua of ontumocimiante de lon dédos de las manos. 52. 8 dolor do tos hambros dura entre 8-10 min 53. El tiompo en que se alcunzi la muixima intonsidad del dolor de cabeza os variable, 54. A aumentar ol dolar de cabeza aparocen otros sintomas que Indican actividad de todo of coretsra, 55. La luz y al ruido son dos cle las caunan del dolor de cabeza, 56, La migaha no parmite damnit al pacianve, ‘57. Los ninos logan datonar ef color do cabeza vortande, 2 E! suefo y of vorito son doa de las formas an que mis frecuontemanle se letione Ja migrana, 89, La fase prodromal de la migraiia he pico eatuciada desde hace mucho tiempo, 60, E aura ele ta migra felativarnente lonta entormedacies, ‘08 un singor quo ne extlende a Una voloeidad A compara con la Velocidad dal aura en otras ve VE ve VE VF VE VF VF ve VE VF ve ve VE ve onGENETICS AND EPIDEMOLOGY Pee a ea Afamily history of migraine, with an immediate relative affected, is common, With a migraine prevalence of 10% in the population, this |s to be expected (most people can muster 10 first or second degree relatives); nevertholess, striking family histories of migraine are 8 commonly encountered, each generation being involved, usually via the temaie line. A genetic component must be at work, although It adds litle to current understanding, Epidemology offors mare insights. 9000 children aged 7:9 showed an equal prevalence (2.7%) In boys and girls, but in higher age groups 10 the prevalence rose more in gir's than in boys. Additional evidence of a horrional element comes from the affects of oral contraceptives, which can initiate of increase the frequency of migraine, and of pregnancy, which alleviates in 60-70% of cases: in some women migraine |s strictly related to the onset of menstruation (48h), and it may cease at 18 menopause. Although these observations seem to implicate femals harmonas, alternative explanations are possible: we have only to remember how the improvement of rheumatoid arthritis in pregnancy led to discover corticosteroids. The effect might, for example, be mediated via glucose: 20 pregnancy alters glucose metabolism towards the diabetic state; corticosteroids (which raise blood glucose) terminate status migrainosus, diabetes may alleviate migraine; and insulin-induced hypoglaecemia in diabetic migraineurs can provoke migraine attacks.61. Las historias familiaros de migrana suolon inclulr un parionte cercane con a ‘mismo pactecimlento, (62. En algunas tarniias ol porcentale de onfermos con migrate alcanza hanla al 10% do sua miombron, (63. Ee do osperarae que an Una Tarnlin con Nistaa do MigRaNA, a paeteesNtiontO Ke Hogue a prosontar hasta on clog familiares do primer © segunda qracto, ‘64. La migrina suelo presortarse on varlas Genaracionos do mujeres da la misma farniia, 65. En la migrata parece haber \un factor gendtiea que nas permite entender major ‘ute padocimiento, 66, Los ostudios apidomioligeos incican quo a mayor edad, mayorns pouibiidadon do que ta migrate a8 presente on la poblacion tomenina. 67, El empleo de unticonceptivos orales tavorece la apariclén de migraha GH. Bi embaraze favorege ta aparicion de in migrana, 69, fn algunan mujoran, la migrarw danaparece Al principio de la menatruacion 70, Ei heaho de que la migrafa pueda cesaparecer en la menopausia indica que ‘existe una relaciin entre horminas y ol padecimianta, 71, El uso de corticoesteroiios pant tratar ta artritia reumutoide durante ol embaraze lieve a doscubvir las vertajan de lon miamos on of tratamiento de la migraha. 72. Lon corticonsterokles pueden allvar un estado migrafoso por ol cambio en et metabollsmo de fa glucosa durante o! embarazo 73. Los conicoesteroides pueden provocar diabetes on la emburazada. 74 Low corticoostersidles oy la emmbarnzada pueden an alguies ena producir eatados migrnoson, 75, En pacientes clabética migranonos ta aplicncién clo inutsiria parade inclucie aiaques do migrate, VF ve VF ve ve ve ve ve VF ve VF ve ve vF veHYPERVITAMINOSIS D ASSOCIATED WITH DRINKING MILK in Vitamin D nas been added to milk In the United States since the 1930s to prevent rickets. We report the unusual o¢eurrence of eight cases of vitamin D intoxication that appear to have been caused by excessive vitamin D fortification of dairy milk, 5 Metods Medical records were reviewed and a dietary questionnaire was gent to eight patients whe had unexplained hypervitaminosis . Vitamin D analyses with high-pertormanes liquid chromatography were performed on samples of the patients’serum, the dairy milk they drank, and the vitarnin D concentrate acidad to the milk. 10 Resu/ts, All eight patients drank milk produced by a local dairy in amounts ranging from 1/2 to 3 cups (118 to 710 ml) daily, All had elevated serum 25-hydroxyvitamin O concentrations (mean|(SO], 731434 nmol par liter [299174 ng per millliter)), Six of the eight pationts hac elevated serum vitamin D3 concentrations. Of the eight patients, seven 15 had hypercalcemia and one had Nypercaiciuria but normocaicemia (mean serum calcium, 3.140.51 mmol per liter (12.62. mg per deciliter)). Analysis ol the dalry's vitamin D-tortified milk reveaied Concentrations of vitarnin D3 (cholecalciferol) that ranged from undetectable to as high as 232.565 1U per quart (245,8401U per liter). An 20 analysis of the concentrate that waa used to fortify the milk, labeled as Sontaining vitamin D2 (ergocalcitero!), ravealedt that it contained vitamin D3,1, Antas de 1920 se agregate vitarnina D a (a leche de vaaa. 2 El raquitiamo se evita con la vitamina © que aumonta ta absoroign cle calcio y fosloro, 8. Son comunes las casos de Intoxicacidn por exouso de vitamina O. 4, 30 reportaron varios sujetoe con nparente axcesg de colenalcilaral 6. Los pacientes eon hiporvitaminosla D ravisaron sus Informen mécheos 6, Algunos pacientes no pudieron oxplica’ al doctor la causa de la itoxicacion que sulrlan, 7 Los paciontos con hipervitaminuats D rocibioron un cuwationarlo preguntanco sobre sun hibiton dietéticon, 8, El analisin cel auero de los pacionion se hiee por medio de la cromatogratia Hquiuar Ue atta reoEiONy 9. Los pacientes consumian dlariarionto (ros vasos y medic de lveho 10, No todos lox pacientes consumian lu leche di ka misma lecheris, 11, Todos los pacientes presentabar una alte Concentraciin de vitarnina O38 workea 12. Biote pucionion tuvioran concentracianos allan do calelo en la sangre, 48. A.uno de lox ocha pactentos ue le encentré paca enntidad do calle wn la rina y ‘onlaanngre, 1, Gn todos [ow andlisis do la lochw siorypro so datocté YN alte eorcantrado de vitarninw D3, 16, El concentrado quo se utlléaba pars errlquecor la leche tenia un error ery la, otiquata, VF VF VE VF VF ve VF VE VE VF VE VF vF VF VFIl HYPERVITAMINOSIS D ASSOCIATED WITH DRINKING MILK METHODS All patients had an elevated serum 25-hydroxyvitamin D(2s(OH)D) concentration, and none reported taking supplemental vitamin D as either cod-liver oll or a vitamin D supplement, Patients or their guardians signed forms authorizing the release of information and subsequently 5 completed a dietary questionnaire, ‘The questionnaire was designed to obtain Information about toad Intake (Including brand names, types of food, and amounts consumed) and the use of vitamin or calciuri supplements, Some of the foods asked about may contain vitamin D; they included cod-iver oil, fish oll, eggs, 10 cereals, and milk. Although milk is the only dairy prociuet that is fortified with vitamin D In the United States, information on the ingestion af other dairy products was sought, since these foods are rich in calcium, Samples of the vitamin O concentrate and raw milk used by the dairy (before fortification) and of various types of vitamin D-fortified 8 battled milk were obtained on two occasions directly from the clalry by a Massachusetts Department of Health inspector, The concentrations of vitamin D in serum (normal range, 1.3 to 65 nmol per liter (0.5 to 25 ng per milliter}), vitamin D concentrate (measure In triplicate) and milk were measured by a procedure described elsewhere. Analyses by mass 20 spectrometry were performed by eluting the sample from a 3-m octadacyisilane column (measuring 4.6 mm by 7.5 em) with 80 percent aqueous methanol. The effluent was then mixed with 0.1 mol of ammonium acetate per liter, and the mixture was introduced directly into a Vestec (Housten) thermogpray mass spectrometer (block, 230$C; 25 vapor, 200$C) under the control of a Teknivent (St, Louis) data system,16. Los pacientes con un alte nivel sérico de viamina informaron que eonsumian aceite da higadle de bucalua y vitunina D 17, 80 enconttd una alta concentraciéi de vilamina B on los pacientes que negaron consumir acelte de higado de bacalan. 18. Se encontro tambidn una concentmcion alta de vitamina D en loa pacientes que afirmaron conaumir Un supiemento co in mara, 19, Los pacientes Hlonaran un cugulionario vobre sus habitos diotétinan y ppositeriormonte nus quarcianes firmaron la autorlzacién para qua se publicarany los dates. 20, El] cuwstionarlo no Inclula preguntas sobre of consumo dé suplamontoa vitarninicos © de catoto, 21. El cuostionario inclula preguntas sobre la cantidad de comida que el paclente sonaumia, 22, Se pregunté sobre algunos allmentos que puciaran cantener vitarni B 23, Sp progunté sobre algunos alimentos eeriquécides ean vilamina B carne coroales, huevos y locho, 24, Se pidid Inlormacion sebro ol consumo de procuctos ldcteos enriquocicios can vitamina O. 26. La.lecho 08 6! Ginico producto lacteo enriquecida con Viamina D ot lox Estacion Unidos. #6, El Departamento de Salud cle Massachusetts obtuve mucstras de leche sin parteurizar a la que ee habla afedkto vitarnina D. 27. Uno de los inspectores obtuve trea tipos de muastras do granjas lecheran an dos ocasiones, 28, Lalocha embotellada contra de | 9)4 85 nmol a vitaenina D poor lites, 29, HI inspoctor dol Dopartamonto de Salud de Massaehuserts obtuve las muvetras do loeho. 40. La vitamina D tuo analizada por espectrometria ce masas, despuds do oluit law muestras a través de column do oetadoctcllane, VF VF VF ve VF ve VF VE ve VE VF ve VE VF ve 3Th BIAS AND 'OVERCALL' IN INTERPRETING CHEST RADIOGRAPHS IN YOUNG FEBRILE CHILDREN 20 25 30 Few studies have examined the diagnostic validity of the examining physician's Interpretation of chest radiographs in young febrile children, and rane (to our knowledge) the extent to which the “official” (ie, the radiolog'st’s) reading may be biased! by the access to the examining physician's reading and to other clinical information. The authors studied 287 consecutive chest radiographs obtained in 286 febrile childran 3 to 24 months of age without chronic cardiopulmonary disease or known asthma who presenied {0 a children's hospital emergency department between March 1589 and August 1990, The readings by treating pediatricians, official pediatrc radiologists, and a “blind” pediatric radiologist were compared. Official radiologists had access to the treating pediatricians’ reaciings anc clinical information provided on the radiography requisition. The blind radiologist knew only that each child was 3 (0 24 months of age and febrile, and he was asked to judge the presence or absence of preurnonia, Using the blind raciologist’s reading as the “gold standard” for judging validity of treating physicians’ and official radiologists’ readings, sensitivity (.677 vs. 647), specificity (828 vs, 649), positive predictive value (PPV, .537 vs. 571), and kappa Index (k, .482 vs. 478) were quite similar, By contrast, agreement by the treating physicians was consicerably higher with the official radiologists’ raiding a% gold stanciard: sensitivity — 746, specifity =.922, PPV ®=.795, anc k =.688. When the treating physician's reading was positive, the official radiologists’ positivity rate was much higher than the blind radiolagist's (74.4% vs 51.8%, 008), sensitivity was high (884) but specificity was low (496), PPV was 669, and k was .926, When the treating physicians’ reacing was negative, howaver, the pattern was reversed: positivity = 8.5% vs 12.8% (P not significant), sensitivity .240, specility = 837, PPV » 353, and k =.205. Surprisingly, none of the three sets of readings appeared to be influenced by the reporting of clinical signs and symptoms on the radiography requisition, These results indicate that official radiologists are strongly biased by the treating physician's reading, Since such a bias can lead to unnecessary antibiotic treatment and hospital admission, strategies to reduce It should receive high priority. i31, Hay pooos estudlos sobre la validez dlagndatica del médico quo interpreta radiografias do torax do nifios con flobro 22. Existen multiples @studios canccielos por el auter sobre cdma la lectura det médico puede influlr sobre la loctura del radialoge. 38, Se estudlaron las radiografian clo 285 nihos pequaiios. 44, Estos nifios suffian una aleceién cardiopulmonar erénica 34, De 1980-4 1990 fueron ineiuiclos en wl eutudio muchos nies con aan, 36. Las radiogratias do ios nifos quo sulrian asma no ge Tomaran en cuMrta, 37, So compararon las Jecturas de! pediatra y de dos tipoa de radidlogos pecilatras. 3M, Une dé lox fididiogoa dol vatudio solamente sabia ta dud de low Hilhios con fbr 26, Al pedintra quo tenia mix informacion clinica se (9 picid quo indlicara la presoncia ‘o-qusencla do noumoria. 40. Las lecturas del pediatra y de lox radiélogos con mayor informacién clinica mostraran mayor coineldoncis 41, Los dingnosticos del radidiogo “ciego” se utlligaron park juzgar la validez de 108 dlagndsticos de los otroe eepoolalistas on of ostudlo, 42, Somprencentemonte, ninguna cle las tres lesturas colheldia con las manifestaciones y sintomas alinicon 43, El dlagnostico de un doctor puede ester prejuiclada por la lectura dol radtidlogo, 44, Sw puodon ovitar equivecacionos al jas locturas de las radlogratlas we hacen sir dojarse Inlulr por of dlagnostice del doctor, 45, Tan pronto se tenga la Jectura cel raelisiogo ao debe internat at paclento an a hospital y empezar ol tatamiento con antibléticos, VF VE VE VF VE VE VE VF VF VE ve ve VE ve VFDIABETIC GASTROPARESIS DUE TO POSTPRANDIAL ANTRAL HYPOMOTILITY IN CHILDHOOD Case 1 A 10- year-old white boy with IDDM (insulin-dependent diabetes mellitus) for 6 years had complained of abdominal pain for § years. He was treated with H2-histamine receptor antagonists ancl sucralfate for 5 endoscopically and histologically documented moderate gastritis and esophagitis, without improvernert. He complained dally of buring epigastric pain occasionally raciating into the chest and of abdorninal distention. These symptoms were not associated with meals, in fact he felt “hungry all the time”, He was constipated; his usual frequency of 10 bowel movements was once weesly. He had required multiple hospitalizations for diabetic ketoacidosis (DKA) in the precading 12 months, Multiple insulin regimens had been employed without satisfactory metabolic control, despite excellant patient compliance. At the time of our evaluation insulin was continuously delivered 15 subcutaneously by a pump. Physical examination revoaled a height at the 75th percentile for age and weight at the 55th percentile for age. The child was solemn and appeared depressed, The rest of the examination was normal, including a. stool nagative for occult blood, Esophagogastroduadenoscopy and 20 biopsies showed gross and histologic evidence of esophagitis and mild antral gastriris. Treatment with metoclopramide (Reglan, AH Robbins, Ine) resulted in reduced abdominal pain but was discontinued because of mental contusion associated with its use. The gastric emptying of solids Tasted with a meal of omelet tagged with technetium TC 99 25 showed 90% of tracer remaining In the stomach after a 0-minute study (normal 50%), The gastric emptying of liquid tested using radiolabeled orange juice showed that 23% of the tracer remained In the stomach after G0 minutes (normal < 20%)7, 1 20, a ¥ 20, 27, 20. 20, Los pacientes con un alto nivel adring do vitarting B informaren que eensurian aceite de higaclo de bacalaa y vitamina D. 8 enconted una alta Goncontracién ele vitamina B en los padlontes que negaron conaumir acelte de higada do bacalao, So encontrd también una coneentracion alta de Viaming D er los puckartes que aalimmaran consumir un auplornenter de la rior Lob pacientes llanaron un cuvsilonario sobre ous hablios dietéticos y posteriarmenie sus quaralanes lirnaran la aulonancion paca que se pubsiaran\ Joa datos, E) cusstionario no Inelult proguntas sobre o consumo co suplomenios vitarninicos 0 do ealcl, ! cunationario ineluia pregurvas sobre la carnidad da camida quo of pasionte congurni, So progunté sobre algunos almontos quo pudlorn contener viearnina ©. Sp progunto sor algunos alrnontas onriquecitos con viamina © como corpales, Nuevos y Ieeho, 80 pidid informacin sobre ol consumo do productos lictoos orviquecielos ex vtamina D, La Iecho 6s al tinieo producta likctoo onnqueeile con vitamifa Ban lon Estados Unidos, El Departamonto de Salud de Mansactusotts obtuvo muvstraa de ieahe ain Pasteurizar a la que so habia afadiclo vitamina O, Uno da ia inapoctoros abtuve tros tiyas eo ruentran do granjas lecheras on clos ocasiones, a lacho embotellada cortenia de 1.2 «65 nmol de vitarnina © por litt El inspector del Dopartamanto de Saluel de Massachusetts obtuve tas musstras da leche, La vitamina B fue afalizada por cspoctrometria de masas, despude de elult lan muesiras a travis de colummas de ootadecilcilana, ve VP VE VF vF ve VF ve VF ve VF VF VF VF aBIAS AND 'OVERCALL’ IN INTERPRETING CHEST RADIOGRAPHS IN YOUNG FEBRILE CHILDREN Few studies have examined the diagnostic validity of the examining physician's Interpretation of chest radiagrapns in young febrile children, and none (to our knowledge) the extent to which the “otficlal"(ie, the radiolagist’s) reading may be biased by the access to the examining 5 physician's reading and to other clinical information. The authors studied 287 consecutive chest radiographs obtained in 286 febrile children 3 to 24 months of age without chronic cardiopulmonary disease or known asthma who presented to a children’s hospital emergency department between March 1989 ane August 1890. The readings by 10 treating pediatricians, official pediatric radiologists, and a “blind” Pediatric radiologist were compared, Otficial radiolagists had access 10 the treating pediatricians’ readings and clinical information provided on the radiography requisition. The blind radiologist knew only that each child was 3 1 24 months of age and (ebrile, and he was asked to judge 15 the presence or absence of pneumonia, Using the blind radiologist's reading as the “gold standard!” far judging validity of treating physicians’ and official radiologists’ readings, sensttivity (.677 vs. 647), specificity (828 vs, 849), positive prodictive value (PPV, .537 vs. 571), and kappa Index (&, 462 vs. 478) were quite similar. By contrast, agreement by the 20 treating physicians was considerably higher with the official radiologists’ reading as gold standarc: sensitivity ~ 756, spectity ~.922, PPV “798, and k —.688. When the treating physician's reading was positive, the official radiologists” positivity rate was Much higher than the blind radiolagist’s (74.4% vs 51.8%, P.005), sensititvity was high (864) 25 but specificity was low (.436), PPV was 663, and k was .326, When the treating physicians’ reading was negative, however, the pattern was teversed: positivity = 8.5% vs 12.8% (P not significant), sensitivity — 240, specify = 937, PPV = 353. and k = 205. Surprisingly, nane of the three seis of reacings appeared to be influenced by the reporting af 30 clinical signs and symptoms cn the radiography requisition, These results indicate that official radiologists are strongly biased by the treating physician's reading. Since such a bias can lead to unnecessary antibiotic treatment and hospital acimission, strategies to reduce it should receive high priority.31. Hay pocos estudios sobre Ia valiciez dlagnéstica de! médico que interpreta radlografias do Wrax de ninos can tiebre, 32. Exinten miltiples estudllon conoeletes por et autor sobre cdmo ta lectura dol médico puede intluir sobre la lectura dol facidlogo, 33, Se estudiaron lus radiogratins clo 286 nibon poqueioa, 24, Estos niios wufrian una afoccian cardiopulmonar cranica. 35, Do 1988 a 1990 fueron inclulclon on al estudio muchos nitios corm sma, 86, Las radlogratiag de los niftos que wufrian asma no 6 tomaron en cuenta. 37, 30 compararon las locturas dol paciatra y do dow tipos do radislogos pciatras ‘sabla la edad de lon nifios con flobro 38. Uno da low tadiatogos do! estudio olama 39. Al podlatra que tenia mas fotormacion clinica ae te pidlé que indlcara la presencia © ausencia do noumonia 40, Lag iectums del pediatra y do joe radidlogos con mayor Informacion clinica mostraron mayor calneidencia, 41. Lon diagnéstiogs del radidloge “clego” se utilizaran para |uzgar la valldez de low diagndstions de lox otros eapecialintan on ol extudia, 42, Sorprendentemonte, ninguna de lap (ros loetyras eoinektia con las maniteataciones y sintomas clinioos 49, El diagnéstico do un dectot pucce estar projulclado por la lectura del radishogo. 44, So puoden ovitar equivocaciones si las \ooturas de jas mdiogratlas se tween sin ojarse influlr por el dlagndstico cet doetor. 46, Tan pronto se tenga la loctura det radiGiogo se debe internar al paciynta on ol hosaital y ampezar el tratamiono con antibétien: VF VF vF VF VF VF ve VF VF VF VF VF VF ve VE 33DIABETIC GASTROPARESIS DUE TO POSTPRANDIAL ANTRAL HYPOMOTILITY IN CHILDHOOD Case 1 ‘A10- year-old white boy with IDDM (ingulin-dependent diabetes mellitus) for 6 years had complained of abdominal pain for § years, He was treated with H2shistamine receptor antagonists and sucralfate for 5 endoscopically and histologically decumented moderate gastritis and esophagitis. without Improvement. He complained dally of burning epigastric pain cecasionally radiating into the chest and af abdominal distention. These symptoms were not associated with meals, in fact he fall “hungry all the time", He was constipated: his usual frequency of 10 bowal movaments was ones weekly, He had required multiple hospitalizations for dlabetic ketoacidosis (DKA) In tha preceding 12 months, Muttiple insulin regimens had been employed without satisfactory metabolic control, despite excellent patient compliance, At the time of eur evaluation insulin wes continuously delivered 18 subcutaneously by 8 pump, Physical examination revealed a height at the 75th percentile for age and weight at the 56th percentile for age, The child was solemn and appeared depressed. The rest of the examination was normal, including 4 stool negative for occult blood, Esophagogastroduedanoscapy and 20 biopsies showed gross and histologic evidence of esophagitis and mild antral gastriris, Treatment with metaciopramice (Regian, AH Rabbins, Ine) resulted In reduced ascorninal pain but was discontinued because of mental confusion associated with its Use, The gastric emptying of sollds Tested With a Meal of omoiet tagged with technetium TC 8B 25 ‘showed 90% of tracer remaining in the stomach after a 90-minute stuely {normal 50%), The gastric omptying of liquid tested using radiolabeled orange |uice showed that 23% of the tracer remained in the stomach aftar 60 minutes (normal = 20%)Case 1 46. A white boy had complained of abdominal pain tor 6 years. 47. After treatment with H2-histamine receptors antagonists she showed a litle improvement. 48. He complained of pain and abdominal distention related to food intake. 49. He had egigastric pain diverging into the chest. 50. The boy suffered most during meals 51. His appetite had been diminishin 52. He evacuated at intervals of two o three times a week. 53. He had been hospitalized for 12 months. 54. His metabolic control was not satisiactory despite having a wide margin of resistance to the disease 56. The boy's weight was below average for his age. 56. There was absence of blood in faeces. 57. Metoclopramide decreased the abdominal pain but produced mental confusion. 58. He had severe antral contractions after a meal of omelet. 59, The patient had delayed gastric emptying of solids. 60. Radiolabeled orange juice showed that the emptying of liquid after an hour was normal, VF VF VE VE VE VF VE VE VE VE VE VF 35ll DIABETIC GASTROPARESIS DUE TO POSTPRANDIAL ANTRAL HYPOMOTILITY IN CHILDHOOD Cage 2 4 18-year-old white girl with |ODM (Insulin-dependent clabates mellitus) for 8 years had ketoacidosis every 4 weeks for § years prior to evaluation. For 4 year she had been complaining of abdominal § distention and vomiting, and she had been taking narcotics orally tor relief of abelominal pain, She was not constipated. Hor insulin doses included 68 U of ingulin zing suspension and 8 U of insulin injection in the morning and 8 U of ingulin zinc suspension at night, On physical examination, she was pale and appeared acutely and chronically il, Her 10 weight was at the 75th percentile for age: height was at the BOth percentile for age. Her abdomen was markedly distended, and bawel sounds were increased. Thare was moderate hepatomegaly and no splenomegaly, Stools were negative lor ageult bload. Contrast fadiagraphy of the stomach anc small bowel was normal. Upper 15 gastrointestinal endoscopy and biopsies showed mild antral gastritis. Gastric emptying of a mixed liquici-solid meal labeled with radioactive Te and indium In 111 showed severe delay in amptying the solid componant (80% of radioactivity remained in the stomach after 1 hour; normal §0%) and normal emptying of liquids.Case 2 61, Ayoung git with IDDM had had acktosls accompanied by an increase In tho blood of ketone bodies (8-hydroxybutyria and acataacetic molds) for 5 yanrs, 62. The girs kotoacidosls of # yours was wvaluutod after a yore. 63, She had been gulfering fromm abelominal distention fora year, 84, Tho patiant had bean givon troatmont for hot abdethinal distention and pain 65. The gi dic Net have any trouble with Lowel evacuation, 66, The patient had several cesen of Injocted insulin every other day. (67, Sho was given a jong duration action insulin and a reguiar inguliry wie in the morning and at night. 68. On physicul examination sho looked vory 69, Tho girl's weight and height wore normal 70, Har abdomen was distended with absence of bowel nouuncls, 71, Thoy found no blood In stool 72, Radiography ot the small bowel showed abnormal rotention of fluid. 73. Tho pationt showed acute antral gastritis, 74, The omptying of salkds was normal. 76, Time for emptying tiquids was typical VF ve VE ve VE VE VF ve ve VF xe ve ve VE VF 37MIGRAINE ; THEORIES OF PATHOGENESIS Sg TESA RE ct Migraine, like gravity, becomes avident only by its effects. The mechanism remains mysterious, and fashion continues to swing between neural and vascular theories that were delineated 100 years ago. Why, despite great biochemical, physiological, and 6 pharmacological advances and 50 years of intensive research, Goes the pathogenesis of migraine continue to elude understanding? Migraine declares itself in compiex sequential patterns of symptoms that differ between indiviciuals and gan even change in one individual during a lifetime. Any theory of pathogenesis has to explain 10 this complexity, and research must depend largely on observations made on of by migraineurs: animals may get headache but they cannot tell us about it; laboratory work tends to be reductionist, focusing on one of two factors and neglecting the whole picture. Over the past 50 years migraine research has been much influenced by fashions in 15 medical science, Any age, however, needs a general migraine theary to create a thought framework on which to base further observations and research, The history of science teaches that a comprehansive theory must satisfy three criteria: it must explain the major manitestations of the condition, by means of a model that contains only afew arbitrary 20 elements, |t must genaralise the phenomena to similar or related entities (‘without generalisation, prediction is impossible"); and it must Include hypotheses that can be supported, refuted, or improved.Case 1 46. A white boy had complained of abcominal pain for 6 years, 47, Alter Treatment with H2-hisiarnirie feceptors. antagonists she showed a littio improvernert, 48. He complained of pain and abdominal distention related to food Intake, 49, He bad epigastric: pain diverging into the chest, ‘60, Tho boy suffered moat during mows, 61, His appetite had been diminishing ‘52. He evacunted at Intervals of two o three times a week. 58. Ho hud boon hospitalized for 12 month 4. His motabolic central was fot satistactory deapte having a wide margin of rewistanee to tho discawe, 186, The boy's woight was below average for his age. 86, There was absence ol blood in fawcen 67. Motoolopramide docroased the alidominal pain but produced mental contusion, 58, Ho fad severe antral contractions anor real cf omelet, 89, The pationt had delayed gauirc emptying of solids, £60, Radiolabeled orange lulew shower! that the emptying af quid after an hour was ‘norma yr VF vP VF ve ve VF vF ve ve VF VF VF VF a5ll DIABETIC GASTROPARESIS DUE TO POSTPRANDIAL ANTRAL HYPOMOTILITY IN CHILDHOOD 10 15 36 Case 2 A 16-year-old white girl with IDDM (insulin-dependent diabetes malitus) for 8 years had ketoacidosis every 4 weeks for 5 years prior to evaluation. For 1 year she had been complaining of abdominal distention and vorniting, and she had bean taking narcoties erally for relief of abdominal pain, She was not constipated. Her insulin doses included 68 U of insulin zing suspension and 8 U af insulin injection in the morning and 8 U af insulin zinc suspension at night. On physical examination, she was pale and appeared acutely and chronically ill, Mer weight was at the 75th percentile for age: height was at the 80th percentié for age. Her abdomen was markedly distanded, and bowel sounds were incteased. There was medarate hepatomegaly and no splenomegaly, Stools were negative for occult blood. Contrast radiography of the stomach and small bowel was normal. Upper gastrointestinal endoscopy and biopsies showed mild antral gastritis, Gastric omptying of @ mixed liquic-solld meal labeled with radioactive Te and indium In 111 showed sovere delay in emptying the sold component (80% of radioactivity remained in the stomach ater 1 hour: normal S0%) and normal emptying of liquids,