ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundVitamin A supplementation reduces the severity of subsequent diarrheal episodes. This study was conducted to examine the effect of single oral high-dose vitamin A supplementation on the duration of acute diarrhea in 6-to 12-month-old infants who are not malnourished.MethodIn this double-blind, randomized, placebo-controlled study, infants who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Diarrheal Diseases Training and Treatment Unit with acute diarrhea were randomly assigned either to a group receiving a single oral dose of 100,000 IU vitamin A or placebo. There were 60 infants in each group. All infants were followed up until the diarrheal episode ended. Serum vitamin A levels were determined both at admission and 2 weeks later.ResultsNo effect of vitamin A supplementation could be demonstrated on either the total duration of diarrhea (7.4 ± 3.2 days in the treatment group vs. 7.8 ± 3.1 days in the placebo group) or on its duration after intervention (3.8 ± 2.3 days in the treatment group vs. 3.9 ± 1.9 days in the placebo group;P> 0.05 for both comparisons). Serum vitamin A levels were not significantly different at admission (23.5 ± 9.7 &mgr;g/dL in the treatment group vs. 24.1 ± 9.7 &mgr;g/dL in the placebo group;P> 0.05) nor at the end of a follow-up period of 2 weeks (treatment: 33.3 ± 13.7 &mgr;g/dL, placebo: 35.2 ± 11.2 &mgr;g/dL;P> 0.05). However, the increase in serum vitamin A levels at the end of the 2-week follow-up interval for infants in both the treatment and placebo groups were found to be significant compared with levels at admission (P< 0.01). The mean weight gain in both groups were similar by the end of the first month (6.9 ± 5.0% in the treatment group vs. 6.3 ± 4.2% in the placebo group;P> 0.05).ConclusionNo effect of oral vitamin A supplementation on serum vitamin A levels, duration of diarrhea, or weight gain during an acute diarrheal episode could be demonstrated in our study group of infants between 6 and 12 months of age who had no malnutrition.

ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundGilbert syndrome as a rule becomes manifest in adolescence or in early adulthood; it may be transferred by the donor to orthotopic liver transplant (OLT) recipients.MethodsWe examined the frequency of Gilbert syndrome in 46 OLT pediatric recipients who had a follow-up of 1 year or more. Diagnostic criteria included unexplained chronic or recurrent unconjugated hyperbilirubinemia; its increase after reduced caloric intake plus prolonged fasting, without changes of the proportion of conjugated bilirubin; and high relative amounts of serum unconjugated bilirubin IXa and prevalence of the monoglucuronide over the diglucuronide.ResultsOf the 46 patients, 42 had normal bilirubin values. Only four otherwise healthy OLT recipients showed hyperbilirubinemia and normal conjugated fractions. Liver donors had been four men. Hyperbilirubinemia persisted with a fluctuating pattern for the whole follow-up after OLT in all. Total bilirubin level in blood samples obtained after reduced caloric intake and prolonged fasting became notably higher than basal values, whereas the proportion of conjugated bilirubin remained stable. High relative amounts of unconjugated bilirubin IXa and prevalence of the monoglucuronide over the diglucuronide were found. Finally, DNA from liver donors' lymphocytes was available for one jaundiced and two nonjaundiced patients: tests for abnormalities in the promoter region of the gene for the enzyme bilirubin uridine diphospho-glucuronosyltransferase were in agreement with a diagnosis of GS in the former one.ConclusionsGilbert syndrome may have an unusual early presentation in pediatric OLT recipients.

ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundTo determine normal ranges of gastroesophageal reflux (GER) in the proximal esophagus, measured with continuous pH monitoring. Normal ranges in the distal esophagus have been published. Because esophageal pH monitoring is frequently performed in children with atypical manifestations such as chronic respiratory disease, and because one of the possible pathophysiologic mechanisms may be (micro-)aspiration, it may be relevant to establish normal ranges in the proximal esophagus.MethodsTwenty-four-hour pH monitoring was performed in 200 children with suspected GER disease. The mean age of the patients was 4.5 months (range, 0.5–17.0 months). After initial analysis, patients were divided into three groups according to the reflux index (RI) in the distal esophagus, because it could be speculated that the amount of reflux reaching the proximal esophagus depends on the amount of reflux in the distal esophagus: Group I (n:120) children had a distal RI of less than 5% and were considered normal, group II (n:50) had a distal RI of 5% to 10% and was considered to have intermediate disease, and group III (n:30) had a distal RI of more than 10% and was regarded as pathologic. The following parameters are calculated: the RI, the total number of reflux episodes, the number of reflux episodes lasting more than 5 minutes, the duration of the longest reflux episode, and the acid clearance time (ACT).ResultsThe median RI in the distal esophagus was 3.8 ± 0.34 (standard error of the mean [SEM]), and in the proximal esophagus, the RI was 1.2 ± 0.23. In group I patients, the RI in the proximal esophagus was 0.5% ± 0.09%, in group II the RI increased significantly to 2.75% ± 0.34% (P[group I compared with group II] < 0.01), and in group III the RI was 6.15% ± 0.96% (P[II-III] < 0.01). The number of acid reflux episodes in group I was 17.0 ± 2.27, in group II the number increased to 62.5 ± 8.18 (P[I-II] < 0.01), and in group III it reached 102.0 ± 23.9 (P[II-III] < 0.05). Also the duration of the longest reflux episodes and the number of reflux episodes lasting more than 5 minutes increased from group I to group II, and from group II to group III. The ACT was shorter in the proximal esophagus (group I 0.3 ± 0.06 minutes; group II 0.48 ± 0.07 minutes,P[I-II] = not significant [NS]; group III 0.56 ± 0.17 minutesP[II-III] = NS) than in the distal esophagus (group I 0.49 ± 0.03 minutes,P[proximal ACT compared with distal ACT] < 0.05; Group II 0.76 ± 0.05 minutes,P[proximal-distal] < 0.01; Group III 0.89 ± 0.09 minutes,P[proximal-distal] = NS) suggesting more effective esophageal clearance in the proximal esophagus.ConclusionsProtection of the proximal esophagus from acid reflux is significantly related to the incidence and duration of reflux measured in the distal esophagus. These normal ranges in the upper esophagus will be helpful in the interpretation of upper esophageal pH monitoring data.

ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundMilk formulas enriched with water-soluble fibers are a first-line measure for infants with gastroesophageal reflux. However, it has been reported that these compounds could affect gastric emptying. The aim of this study was to evaluate the effects of these thickeners on gastric emptying time in infants with frequent regurgitation or vomiting.MethodsForty-seven infants, aged 1 to 12 months, with uncomplicated gastroesophageal reflux underwent two ultrasound evaluations of gastric emptying time after receiving either a standard formula or a formula enriched with 0.4 g galactomannan per 100 ml diluted milk. Gastric emptying time was calculated by measuring the antrum area at baseline and at defined intervals over the next 3 hours.ResultsThe gastric emptying time (mean ± SD) for the standard and the thickened formula was 136 ± 33 and 133 ± 34 minutes, respectively. There was no significant difference in the gastric emptying patterns of the two formulas. Gastric emptying time was longer after the standard formula in 15 of the 47 subjects, shorter in 15 of the 47, and the same in 17 of the 47.ConclusionsThe ingestion of a water-soluble fiber-enriched formula does not have any significant influence on the gastric emptying time of infants with frequent regurgitation or vomiting.

ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundA stable isotope tracer method to quantify the synthesis of proteins of hepatic origin in response to feeding is described. The response of albumin synthesis on one mixed meal in a piglet model was investigated and the intragastric and intravenous administration modes of13C-valine were compared.MethodsThe fasting and postprandial fractional synthesis rates (FSRs) of albumin in 15 piglets were measured while infusion rates of13C-valine were changed in anticipation of the increased appearance of the tracee after a single liquid food bolus (30 mL/kg infant formula).13C-valine enrichments in albumin hydrolysates at regular time intervals were determined with gas chromatography–combustion isotope ratio mass spectrometry.ResultsThe intravenous mode (n= 8) showed constant plasma &agr;-ketoisovalerate tracer-to-tracee ratios (coefficient of variation range: 1–8%), and a 27% increase in albumin FSR after the food bolus (mean FSR ± standard error [SE]: fasting 14.4% ± 1.6% vs. postprandial 18.3% ± 2.2% per day;P< 0.005). In the intragastric mode (n= 7), albumin FSR calculated from the mean precursor values increased 32% after feeding (fasting 14.6% ± 1.5% vs. postprandial 19.3% ± 1.6% per day;P= 0.005), despite absence of constant &agr;-ketoisovalerate enrichment (coefficient of variation range: 15–31%). The FSRs were not significantly different between both infusion modes.ConclusionsA mixed food bolus increases albumin FSR in growing piglets by approximately 30%, irrespective of the tracer administration route. The concept of anticipated precursor steady state is applicable to study changes of hepatic protein synthesis after a single meal. The intragastric mode of tracer administration can be applied as a less invasive method to measure tissue specific protein synthesis in children.

ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundA prospective nationwide screening study initiated more than 20 years ago in Sweden has shown that clinically significant liver disease develops in only 10% to 15% of &agr;1-antitrypsin (AT)–deficient children. This study provides information about 85% to 90% of those children, many of whom had elevated serum transaminases in infancy but have no evidence of liver injury by age 18 years. However, there is relatively limited information about the course of &agr;1-AT–deficient children who have cirrhosis or portal hypertension. Based on several anecdotal experiences, we have been impressed by the relatively slow progression and stable course of the liver disease in some of these children.MethodsWe reviewed the course of patients with homozygous PIZZ &agr;1-antitrypsin deficiency seen at this institution since establishing a patient database 16 years ago.ResultsOf 44 patients with &agr;1-AT deficiency, 17 had cirrhosis, portal hypertension, or both. Nine of the 17 patients with cirrhosis or portal hypertension had a prolonged, relatively uneventful course for at least 4 years after the diagnosis of cirrhosis or portal hypertension. Two of these patients eventually underwent liver transplantation, but seven are leading relatively healthy lives for up to 23 years while carrying a diagnosis of severe &agr;1-AT deficiency–associated liver disease. Patients with the prolonged stable course could be distinguished from those with a rapidly progressive course on the basis of overall life functioning but not on the basis of any other more conventional clinical or biochemical criteria.ConclusionsThese data provide further evidence for the variable severity of liver disease associated with &agr;1-AT deficiency and indicate that some patients have chronic, slowly progressing or nonprogressing cirrhosis.

ISSN:0277-2116    

出版商:OVID    

年代:2000

数据来源: OVID