The role of fructose and sorbitol, when ingested together, in the aetiology of irritable bowel syndrome (IBS) is controversial. The aims of this study in IBS patients, therefore, were to compare differences in symptom provocation with various doses of fructose-sorbitol and to relate differences in the extent of colonic hydrogen production after each dose to such symptom provocation. Two different mixtures of fructose and sorbitol--20 g fructose plus 3.5 g sorbitol ('lower' dose) and 25 g fructose plus 5 g sorbitol ('higher' dose)--were administered to 15 patients with IBS and to 24 healthy controls. Breath hydrogen concentrations were determined at 10-min intervals for 3 h after ingestion of each mixture, and the presence and severity of a range of gastrointestinal symptoms were recorded on a standard form before, during, and after the study. Total symptom score in IBS patients, but not controls, was greater (p < 0.05) after the higher than after the lower dose of fructose-sorbitol mixture, and, for the higher dose, symptoms were significantly greater in IBS patients than in controls (p < 0.05). Moreover, the increase in total symptom score between the higher and lower dose mixtures was of a greater magnitude (p = 0.01) in IBS patients than in controls. No significant correlation was observed between the increase in symptom score and the increase in peak hydrogen concentration or the increase in integrated hydrogen response between lower and higher dose mixtures, although these latter increases were at times substantial.(ABSTRACT TRUNCATED AT 250 WORDS)

This review article examines the current status of histopathological and cytogenetic diagnosis, surgical, chemotherapeutic and radiotherapeutic treatment and future directions.

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A previously well 16-month-old boy presented to Sydney Children's Hospital with generalised seizures. There was no history of neurofibromatosis and no family history. Imaging revealed a well-demarcated, frontal intracranial mass at the grey-white matter junction with surrounding oedema. At operation, the tumour was adherent to the underlying brain on its deep aspect but superficially connected to the dura. There was an associated peritumoural cyst. The tumour was biopsied for intra-operative frozen section opinion and excised in its entirety. The specimen consisted of a 25 x 25 x 17 mm nodule of firm cream tissue and separate fragments. Histologically, the tumour was a meningioma with frequent mitoses, necrosis and brain invasion. Optimal treatment, in view of the recurrence risk, includes complete excision and postoperative irradiation. The latter was deferred because of the young age. At follow-up at 26 months, the child was well and free of disease on MRI scan. Paediatric meningiomas are rare, with very few brain-invasive examples in reported series. In infants and young children, few meningiomas have been reported. There are several notable differences between meningiomas in children and adults. This report illustrates these differences.