摘要:

ObjectivesNeonatal lupus erythematosus (NLE) is associated with maternal anti-Ro/La autoantibodies. It is characterized by heart block and/or cutaneous skin lesions, and occasionally liver disease. This study was performed to determine whether idiopathic neonatal cholestasis (INC) represents NLE without its cardiac or cutaneous findings.MethodsSera were obtained for autoantibody analysis from mothers of children with INC (N = 11), biliary atresia (N = 25), other liver disease excluding viral hepatitis (liver disease control subjects, N = 14), and healthy children (normal control subjects [NC], N = 22).ResultsThe characteristic serologic findings of NLE, high titer antibodies to Ro and/or La, were absent in mothers from all groups. An unexpected finding was the prevalence of autoantibodies in mothers of infants with liver disease of any type. The frequency of maternal antinuclear antibodies at ≥ 1:120 dilution was greater than the estimated frequency in the general population (22% vs. 9%,P= 0.044). The frequency of maternal low titer autoantibodies to 52 kD Ro detected by ELISA was significantly greater than in the NC group (31% vs. 5%,P= 0.014).ConclusionsThe majority of cases of INC do not represent NLE. The frequent presence of autoantibodies in mothers of infants in all neonatal liver disease groups raises the possibility that maternal serologic autoimmunity is associated with neonatal liver disease.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveCoagulopathy is an important cause of morbidity and mortality in patients with liver failure. The benefit of traditional therapies to correct coagulation is often limited and short-lived. Our aim is to identify indications for rFVIIa use and the outcome of treatment in children with liver failure.MethodsA retrospective review from July 2000 to December 2001 was performed to identify consecutive patients with acute or chronic liver failure who received rFVIIa. Prothrombin times (PT) before and after therapy were compared by pairedttest.ResultsFifteen patients were treated with rFVIIa for coagulopathy caused by liver failure. All were receiving fresh frozen plasma (mean infusion rate, 39.7 mL/kg/day) when rFVIIa therapy was started. The mean PT before rFVIIa was 32.0 ± 7.0 seconds. One hour after infusion, the PT normalized to 13.7 ± 2.4 seconds (P< 0.0001) and remained significantly reduced at 6 hours (19.8 ± 5.3 seconds;P< 0.0001). A sustained improvement was maintained during the subsequent 3 days. Five of seven patients with bleeding complications improved clinically after rFVIIa treatment. Two of the bleeding patients also benefited from improved fluid balance as fresh frozen plasma support was reduced. No thrombotic events were attributed to rFVIIa therapy.ConclusionsIn patients with liver failure, rFVIIa therapy quickly normalizes the PT and maintains improved hemostasis, even when coagulopathy has been refractory to fresh frozen plasma. Therapy subjectively reduces clinical bleeding and can improve fluid balance, without complications.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesCertain milk factors may help to promote the growth of a host-friendly colonic microflora (e.g. bifidobacteria, lactobacilli) and explain why breast-fed infants experience fewer and milder intestinal infections than those who are formula-fed. The effects of supplementation of formula with two such milk factors was investigated in this study.Materials and MethodsInfant rhesus macaques were breast-fed, fed control formula, or formula supplemented with glycomacropeptide (GMP) or &agr;-lactalbumin (&agr;-LA) from birth to 5 months of age. Blood was drawn monthly and rectal swabs were collected weekly. At 4.5 months of age, 108colony-forming units of enteropathogenicE.coliO127, strain 2349/68 (EPEC) was given orally and the response to infection assessed. The bacteriology of rectal swabs pre- and post-infection was determined by culture independent fluorescence in situ hybridization.ResultsPost-challenge, breast-fed infants and infants fed &agr;-LA-supplemented formula had no diarrhea, whilst those infants fed GMP-supplemented formula had intermittent diarrhea. In infants fed control formula the diarrhea was acute.ConclusionsSupplementation of infant formula with appropriate milk proteins may be useful for improving the infant's ability to resist acute infection caused byE.coli.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveApproximately half of extremely low birth weight infants have feeding intolerance, which delays their achievement of full enteral feedings. Erythromycin, a motilin receptor agonist, triggers migrating motor complexes and accelerates gastric emptying in adults with feeding intolerance. Few studies have assessed the efficacy of this drug in preterm infants with established feeding intolerance. This study was designed to assess the efficacy of erythromycin in feeding-intolerant infants, as measured by gastric emptying, maturation of gastrointestinal motor patterns, and time to achieve full enteral feedings.MethodsSubjects were 27 preterm infants who were admitted to the neonatal intensive care unit and who did not achieve full enteral feeding volumes (150 mL/kg/day) within 8 days of the initiation of feedings. In a controlled, randomized, double-blinded clinical trial, infants received intragastric erythromycin or placebo for 8 days without crossover. At study entry, the authors recorded motor activity in the antrum and the duodenum during fasting, in response to intragastric erythromycin (1.5 mg/kg) or placebo, and in response to feeding. Gastric emptying at 20 minutes and transit time from duodenum to anus were determined. Each infant then received erythromycin or placebo for 8 days, and feeding characteristics were prospectively tracked.ResultsGastric emptying and characteristics of antroduodenal motor contractions were similar in the two groups, as were the transit times from duodenum to anus. Feeding outcomes were comparable in the two groups.ConclusionIntragastric erythromycin does not improve feeding tolerance in preterm infants with established feeding intolerance because it fails to improve gastrointestinal function in the short or long term.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIn chronically ill children who refuse to eat, surgery to correct anatomic problems and behavioral treatments to overcome oral aversion often succeed. A few patients fail with standard treatments. The aims of the study were to: 1) investigate motility and gastric sensory abnormalities and 2) describe treatment that was individualized based on pathophysiology in children who failed surgery and behavioral treatments.MethodsWe studied 14 patients (age 1.5–6; mean 2.5; M/F: 7/7). All had a lifelong history of food aversion and retching or vomiting persisting after feeding therapy and fundoplication. All were fed through gastrostomy or gastro-jejunostomy tubes. We studied esophageal and antroduodenal manometry, and gastric volume threshold for retching. We identified when gastric antral contractions were associated with retching and pain. A multidisciplinary treatment program included a variable combination of continuous post-pyloric feedings, drugs to decrease visceral pain, drugs for motility disorders, and behavioral, cognitive, and family therapy. We interviewed parents 2–6 months following testing to evaluate symptoms, mode of feeding and emotional health.ResultsWe found a motility disorder alone in 2, decreased threshold for retching alone in 5 and both motility and sensory abnormalities in 7. After treatment, 6 of 14 (43%) began eating orally and 80% had improved emotional health. Retching decreased from 15 episodes per day to an average of 1.4 per day (p <0.01).ConclusionsUpper gastrointestinal motor and/or sensory disorders contributed to reduced quality of life for a majority of children and families with persistent feeding problems. A multidisciplinary approach improved symptoms and problems in these children

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundGastrointestinal symptoms have been reported in association with myoelectrical dysrhythmia, where different types of gastric electrical activity have been described. These types of gastric myoelectrical activity and dysrhythmia can be measured by electrogastrography using cutaneous electrodes. Epigastric impedance is a non-invasive method used to study gastric emptying time and gastric phasic activity.At present no study of gastric dysrhythmia, measured with epigastric impedance, has been presented, and the purpose of the present study was to investigate gastric rhythms by means of impedance gastrography in control infants, compared to infants with different gastrointestinal diseases, before and after treatment of their disease.Method21 patients (age 0–2 months) and 40 healthy infants (age 0–2 months) were investigated. The patients suffered from partial or total intestinal obstruction, necrotizing enterocolitis or pyloric stenosis.All infants were fasting and studied during periods of at least one hour. The patients were examined in the acute state and after treatment when possible.ResultsA pathologic result was found in 90% of the patients. A persistent phasic activity pattern was found in 19 of the 21 patients, high frequency phasic activity in 11 of the 21 patients. Short-term phasic activity was only found in 13 out of 40 of the normal infants (32.5%).ConclusionUsing epigastric impedance we found that infants with partial or total intestinal obstruction had gastric phasic activity, which was not found in the control infants. The origin of the gastric phasic activity patterns is unknown, but they may be related to electrical control activity.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundCytokines appear to play a significant role in the pathogenesis of inflammatory bowel disease (IBD) with a predominant Th2 pattern in colonic mucosa of patients with ulcerative colitis (UC). Chemokines and their receptors also regulate the migration of Th1 or Th2 lymphocytes to inflammatory tissues during the immune response. Although adult UC is usually confined to the colon, pediatric UC not uncommonly affects the stomach.AimsThe aim of this study was to compare expression of cytokines, chemokine receptors, and homing molecules in the rectal and the histologically characterized gastric mucosa of pediatric patients with UC.SubjectsSixteen patients (11 girls and 5 boys; median age, 9 years) having all the features of UC were included in the study.MethodsRectal and gastric mucosa obtained from UC cases were immunostained with antibodies against L-selectin, &bgr;7 integrin, CXCR3, CCR3, and CCR5. IL-4 and IL-12 p40 transcript expression was studied by in situ hybridization.ResultsChronic gastritis was found in 93.7% of cases andHelicobacter pylori(Hp) was found in 2 (13.3%) cases. In the rectal and gastric mucosa, CXCR3 was found in perivascular lymphocytes and CCR5 in a subset of CXCR3+ cells in the lamina propria. CCR3+ lymphocytes and IL-4–positive cells were always found, but there was no evidence of IL-12 production. Most of the lymphocytes infiltrating the gastric mucosa expressed &bgr;7 but not CD62L. In contrast, &bgr;7-positive cells were randomly dispersed in the rectal lamina propria, and the fraction of CD3+&bgr;7+ was low.ConclusionsThe authors conclude that gastritis is common in pediatric UC. The presence of CCR3+ lymphocytes, IL-4 transcript expression, without IL-12 p40 production in the stomach and in the rectum suggests a Th2 immune response. The presence of CCR3+, CD62L- activated Th2 cells may suggest that these gastric cells are recruited from colorectal primary lesions.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundActive gastritis, gastric mucosal atrophy and intestinal metaplasia are lesions associated withHelicobacter pyloriinfection. Atrophy and intestinal metaplasia are only seen in adults.ObjectivesWe describe pediatric patients with atrophy and metaplasia, and compare the inflammatory response in these patients to controls.MethodsAs part of a multicenter study of pediatricH. pyloriinfection, gastric biopsy specimens obtained during diagnostic upper endoscopy of 19H. pylori-infected children and 45 uninfected controls were reviewed and graded by using the updated Sydney system. The inflammatory response was characterized using immunohistochemistry for T lymphocytes, B lymphocytes, and macrophages, and TUNEL assay for apoptosis.ResultsHistology ofH. pylori-infected and control biopsy specimens showed active gastritis in 32% and 2% respectively (P= 0.002). Mild intestinal metaplasia was found in 4H. pylori-infected children, in two of whom it appeared to be accompanied by atrophy. Specimens from patients withH. pyloriinfection contained increased numbers of B lymphocytes in lymphoid nodules, and apoptosis in the superficial epithelium and inflammatory cells. T lymphocytes and macrophages appeared in similar numbers in specimens from controls and infected patients.ConclusionsWe describe intestinal metaplasia associated withH. pyloriinfection in children. Since atrophy usually precedes intestinal metaplasia in adults, we suggest that atrophy exists in children. High numbers of B lymphocytes and apoptosis in the surface epithelium are seen in patients withH. pyloriinfection and may be related to the development of atrophy and intestinal metaplasia.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesTo describe the clinical characteristics of children with internal anal sphincter (IAS) achalasia and to evaluate the benefit of intrasphincteric injection ofClostridium botulinumtoxin.MethodsRetrospective review of the medical records of 20 patients (8 male, mean 5.8 ± 4.2 years) with severe chronic constipation and IAS achalasia. Each patient received four-quadrant, intrasphincteric injections of botulinum toxin at a dose of 15–25U per quadrant. Patients were reassessed 4 weeks-18 months after injection. We compared the clinical characteristics of these patients to 20 consecutive children (14 male, mean age 8.1 + 4.6 y) with functional constipation (control group).ResultsThe children with IAS achalasia had earlier onset of symptoms, less fecal soiling, and less withholding behavior than the control children. Response to botulinum injection was rated excellent by the parents in 60% and by the physician in 35% of children. There was wide individual variability in the frequency of defecation after therapy. Duration of response ranged from 1 week to 18 months.ConclusionsChildren with IAS achalasia have clinical characteristics differentiating them from children with functional constipation. Intra-anal injection of botulinum toxin is a safe and effective short-term treatment for these children.

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2003

数据来源: OVID