ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Following a longitudinal study of chronic non-A, non-B hepatitis in Italy and Spain, we evaluated the epidemiologic and clinical features of chronic hepatitis C in 77 consecutively observed children (35 male; mean age, 4 years) without underlying systemic diseases. All subjects were positive for antibody to hepatitis C virus in serum by second-generation tests. Forty-six patients had received blood transfusions in the perinatal period; 12 had a mother with antibodies to HCV in serum (five of these mothers were drug users or partners of a drug user); seven had a history of putative percutaneous exposure; and 12 had not been exposed to any risk factors for viral hepatitis. At presentation, only 22% were symptomatic, mean alanine-aminotransferase levels were three times the upper normal value, and liver histology showed active disease in only nine of 28 cases (32%). During a mean observation period of 6 years, only 11 of 57 patients (19%) complained of symptoms and 11 of 40 cases (27%) had histologic features of active hepatitis. Two patients had severe hepatitis with associated cirrhosis. However, only six of 57 cases (10%) achieved sustained biochemical remission. The clinical features and the outcome were similar in both the posttransfusion and the community-acquired cases. These results indicate that transfusions in the perinatal period are the single most important cause of hepatitis C in otherwise healthy children. Community-acquired cases represent an heterogeneous epidemiologic group in which maternal transmission, whether perinatal or postnatal, could be relevant. Histologically severe hepatitis and cirrhosis seem to be an infrequent feature of chronic hepatitis C virus infection in childhood and adolescence, in spite of persistent liver damage.

ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

From 1980 to 1992, we found false negative results from Technetium (Tc)-99m abdominal scans in seven children with massive gastrointestinal bleeding from ectopic gastric mucosae. Other examinations—including endoscopy, gastrointestinal series studies, an-giography, and Tc-99m-labeled red blood cell scans to search for the source of the bleeding—were all in vain. Positive results were only obtained after repeated Tc-99m abdominal scans. Surgical specimens confirmed that ectopic gastric tissue was the source of bleeding in five patients with Meckel's diverticulum and two patients with enteric duplication.

ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The clinical efficacy of twice-daily cimetidine (20 mg/kg/day) was retrospectively studied in 19 children with gastric ulcer (GU) and 23 with duodenal ulcer (DU) in the active stage. Endoscopically confirmed cumulative healing rates at 2,4, and 8 weeks of treatment were 53.5, 73.7, and 94.7% in the GU group and 15.4, 50.0, and 87.0% in the DU group, respectively. There was no significant difference between the groups at each time point. The mean period of time until complete disappearance of symptoms in the GU and DU groups was 3.5 ± 2.6 and 4.2 ± 3.3 days, respectively (NS). With regard to symptoms, abdominal tenderness rather than spontaneous pain appeared to be a better indicator of ulcer healing. Ulcer recurrence was found endoscopically during follow-up in 2 of 13 GU patients (15.4%) and 11 of 19 DU patients (57.9%); thus, the cumulative recurrence rate of the DU group was higher than that of the GU group (p< 0.05). No adverse effects related to cimetidine were demonstrated during treatment or short-term follow-up. We conclude that twice-daily cimetidine at a dosage of 20 mg/kg/ day is as effective for the symptomatic improvement and healing of peptic ulcer as the conventional three- or four-times-daily regimens. The optimal dosage of cimetidine requires further study.

ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We analyzed the antroduodenojejunal (ADJ) manometric patterns in a group of 19 consecutive children (mean age, 53 months; range, 5 months to 14 years) referred for suspected chronic idiopathic intestinal pseu-doobstruction. Diagnosis was based on typical symptoms, absence of extraintestinal diseases, and structural lesions of the gut at endoscopy and radiology. Surgical full-thickness intestinal biopsies were evaluated in nine patients. Manometry of the stomach and small bowel was performed in the fasting and fed state with a multilumen perfused probe. All patients showed severe abnormalities of ADJ motor activity that were not seen in the eight controls (mean age, 38.2 months; range, 1–9 years). In 12 patients, manometric patterns suggesting neuropathic disease were detected with fasting and/or fed sustained and incoordinated duodenojejunal phasic waves, aberrant propagation and/or configuration of phase III of the inter-digestive motility complex, inability of a meal to convert a fasting into a fed pattern, and prolonged groups of fasting and fed nonpropagated phasic waves. In seven of these patients, histology revealed marked changes of the intrinsic neurons. In four cases, manometry disclosed features suggestive of a myogenic disease, including severe fasting and fed infrequent low-amplitude contractions, sometimes with some degree of propagation; in two of these cases, histology showed morphological abnormalities of smooth muscle cells of the gut wall. In three patients, manometry revealed signs suggestive of mechanical obstruction of the gut, such as repetitive post-feeding clusters and simultaneous repeated broad-based waves; in these patients, more detailed x-ray studies showed organic obstructive causes (ileal lymphoma, Hirschsprung's disease, and intestinal malrotation). We conclude that, in children with symptoms suggesting chronic intestinal pseudoobstruction, manometry of the stomach and small bowel reveals severe gut dysmotility and can help establish the diagnosis and distinguish the underlying disease process.

ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This study is a retrospective review of eight pediatric patients with multifocal intestinal Crohn's disease who underwent strictureplasty with or without concomitant bowel resection between January 1978 and April 1992. The patients ranged in age from 9.9 years to 18.5 years. Indications for surgery were partial intestinal obstruction (n = 6), failure of medial therapy or steroid dependence (n = 4), growth failure (n = 2), and entero-cutaneous fistula (n = 2). Thirty-six strictureplasties were performed in the eight patients (median, 4.5 strictureplasties per patient; range, 1–12). Bowel resection was performed in six of the eight patients in areas where strictureplasty was not feasible. The mean length of resection was 40 cm (range, 15–82 cm). The only complication was intestinal hemorrhage, which was conservatively managed in two patients. The patients were followed for a mean of 19 months (range, 3–55 months). Five patients had a weight below the fifth percentile prior to surgery. Postoperatively, there was a weight gain in seven patients, including all five patients who were originally below the fifth percentile. A statistically significant weight gain was found when a pairedttest analysis was applied to the entire group (p= 0.04). Five of six patients who were on steroid medication at the time of surgery were successfully weaned within 1.5–3 months (mean, 2.3 months) from the time of surgery. Seven of eight patients had relief of their intestinal symptoms. Strictureplasty with small-bowel resection, or perhaps strictureplasty alone, in pediatric patients with multifocal intestinal Crohn's disease can improve gastrointestinal symptoms, promote weight gain, and allow discontinuation of steroid medications. Strictureplasty should be considered for patients who are refractory to medical therapy or dependent on chronic steroid medication for control of their symptoms.

ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

To assess the predictive value of preoperative esophageal manometric study in the outcome of antire-flux surgery, 14 children with severe gastroesophageal reflux (GER) who underwent surgery were studied retrospectively. Five patients had neuromuscular disease; one had been operated on for esophageal atresia. After extended (gt; 20 h) esophageal pH monitoring and/or barium swallow study, all patients underwent preoperative manometric study. After surgery, the patients were followed for 4 months to 4 years. Functional complications were noted after mechanical complications were eliminated. All patients had normal upper esophageal sphincter pressure (UESp); the resting lower esophageal sphincter pressure (LESp) was decreased in four patients, and seven had esophageal body motility trouble. Functional complications occurred in two patients. One was a neu-rologically involved patient who had had a normal preoperative manometric study; the other was the patient who had been operated on for esophageal atresia. No complications occurred in four patients who had had abnormal preoperative manometric studies. We conclude that, in this group of patients, esophageal manometric study has no predictive value in the outcome of the surgical procedure; however, it still would be interesting to elucidate the mechanisms of GER, especially in congenital abnormalities such as esophageal atresia.

ISSN:0277-2116    

出版商:OVID    

年代:1994

数据来源: OVID