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In pediatric Crohn's disease (CD), resection of gut lesions is necessary to remove stenoses and when frequent relapses occur despite nutritional support and medical treatment. After surgery, improved nutritional status and accelerated growth usually follow increased nutritional intake and lower doses of steroids. The aim of this study was to compare energy balance before and after surgery while nutritional intake and steroid therapy were unchanged. Eleven patients, aged 14.5 +/- 2.5 years and with mildly active CD, were explored 1 week before and 1 month after gut resection for stenosis (n = 7) and medical treatment failure (n = 4). Eleven matched children participated in the study as controls. Disease activity was assessed by the Pediatric Crohn's Disease Activity Index and serum orosomucoid concentration. Resting energy expenditure (REE) was measured by indirect calorimetry, and fat-free body mass (FFM) was measured by anthropometry. The patients' mean REE decreased from 46.6 +/- 10.5 kcal/kg FFM/day before surgery to 42.6 +/- 10.3 kcal/kg FFM/day after surgery, while the controls' mean REE was 39 +/- 7 kcal/kg FFM/day (analysis of variance, p = 0.02). After surgery, body weights were not significantly different, but the mean protein oxidation rate was reduced and arm muscle area was increased. Changes in REE per kilogram of FFM per day were not correlated with changes in orosomucoid serum concentrations (r2 = 0.35; p = 0.4). In conclusion, in children with mildly active CD, while nutritional intake and steroid therapy were maintained at preoperative levels, a significant decrease in REE and improved nitrogen utilisation were observed 1 month after resection of the CD gut lesion. This finding suggests better use of energy substrates when CD lesions are removed.

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We wish to draw your attention to an outbreak of equine encephalosis virus (EEV) in Israel. Between October 2008 and January 2009, a febrile horse disease was observed in more than 60 equine premises across the country. Clinical signs included: raised body temperatures, unrest, decreased appetite, edema of the neck, legs, lips and eyelids, accelerated pulse and breathing rates, and congested mucosae. The morbidity ranged from 2% to 100% but there were no fatalities. In the affected stables, the disease infected all breeds, ages and sexes and the duration of illness lasted from between 7 and 30 days.The initial diagnostic investigation was performed by the Kimron Veterinary Institute (KVI), Israel, on nasal swabs, blood and serum samples from affected animals. The tests for WNV and EHV-1 were negative. Initial serological results indicated that the disease was equine viral arteritis (EAV), but no EAV virus could be isolated and PCR tests were also negative. The virus isolates and original sample material were passed on to the Veterinary Laboratories Agency (VLA) in the UK for further investigation.Based on the clinical signs and possible suspect diagnosis, the VLA performed PCR tests for EAV, Togaviruses (Getah, WEE, EEE, VEE, Ross River), and Flaviviruses (Tick Borne Encephalitis, WN, Usutu, Louping ill, Dengue, Japanese encephalitis), with all tests being negative. Using a novel DNA array technique, with subsequent RT-PCR and sequence analysis, the virus was finally identified as EEV.While further characterization of the virus is underway and an extended description of the investigation will be

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