ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Liver transplantation is recognized as the appropriate treatment for end-stage liver disease due to chronic active autoimmune hepatitis. While it was initially thought that the disease did not recur after transplant, it is now generally accepted that adult patients may develop recurrent disease, with studies reporting a recurrence rate of ≤25%. We have noted a higher incidence of recurrent autoimmune hepatitis in our pediatric patients undergoing liver transplant, with a high incidence of associated morbidity.Methods:We reviewed the records of six children followed up for autoimmune hepatitis who underwent orthotopic liver transplant for complications of end-stage liver disease.Results:Of the six, five developed recurrent autoimmune hepatitis at a mean time of 11.4 months after transplant. The disease was aggressive, leading to cirrhosis and retransplant in three patients, within 1 year of recurrence. A second recurrence of disease occurred in all three retransplanted patients. One patient has received a third liver transplant, one has died, and one patient is asymptomatic on medical therapy. Autoimmune hepatitis recurred in all four patients receiving tacrolimus.Conclusion:We conclude that liver transplant for autoimmune hepatitis is likely to be palliative for most pediatric patients. Potent immunosuppressives such as tacrolimus do not protect against the development of recurrent autoimmune hepatitis.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Pediatric patients presenting with colitis, suggestive of inflammatory bowel disease, undergo evaluation with either flexible sigmoidoscopy or colonoscopy. Our objectives were to assess current practice behavior in the evaluation of pediatric patients with colitis and to determine whether flexible sigmoidoscopy or colonoscopy was more cost-effective as the initial evaluation.Methods:Practice behavior and procedure charges were assessed using a nationwide survey, and costs for diagnostic strategies were compared using a decision analysis program.Results:The vast majority of survey respondents would proceed with colonoscopy if colitis suggestive of Crohn's disease was noted in the rectosigmoid area (81%) or if ulcerative colitis extended proximal to the rectosigmoid area (70%). If colonoscopy would follow if flexible sigmoidoscopy suggested either ulcerative colitis or Crohn's disease (67%), then colonoscopy would result in a savings of 23%. If the evaluation was predetermined to be limited to flexible sigmoidoscopy (16%), then flexible sigmoidoscopy was the cost-effective strategy with savings of 29%. If colonoscopy would follow flexible sigmoidoscopy for Crohn's colitis only (13%), there was no clear cost advantage.Conclusions:The most cost-effective strategy depends on the physician's need to know the disease location. Our survey results indicate that most physicians chose to establish the extent of disease in both ulcerative colitis and in Crohn's disease; thus initial colonoscopy would be the more cost-effective strategy. When knowledge of disease distribution is not essential for patient care, flexible sigmoidoscopy can lead to substantial cost savings.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Correlation between clinical parameters and histology changes in cystic fibrosis liver disease has not been documented. The purpose of this study was to determine the histologic spectrum of cystic fibrosis liver disease and the degree to which a clinical scoring system can identify subjects with significant histologic abnormalities.Methods:We reviewed the predictive value of physical examination, biochemical parameters, and a clinical liver score, incorporating physical examination and biochemical parameters, in predicting significant abnormalities of liver histology in 43 cystic fibrosis patients who underwent hepatic biopsy. Biopsies were scored by two masked pathologists for fibrosis, inflammation, inspissation, fatty infiltration, and congestion.Results:Significant histologic disease was present in 56% of patients despite little biochemical or physical examination evidence of disease. No single parameter used in the scoring system predicted the type or degree of the liver disease. The clinical liver score had a sensitivity of 85% and a specificity of 82% in predicting significant histologic changes, yet it was unable to predict the specific lesion.Conclusions:Significant histologic liver disease is common in cystic fibrosis, although the exact nature of the lesion cannot be predicted without liver biopsy. A clinical liver score that was developed for this may be useful in determining which patients require more definitive evaluation.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Although standard formulas for preterm infants promote intrauterine rates of weight gain, fat deposition in preterm infants fed these formulas has been reported to be considerably higher than that in the fetus. We hypothesized that a preterm infant formula with a higher protein:energy (P:E) ratio would promote accretion rates of fat, fat-free mass, and minerals closer to those of the fetus.Methods:As part of a larger study to determine whether accretion rates of fat and fat-free mass closer to those of the fetus can be achieved with a higher P:E ratio, we present a descriptive analysis of 72-h nutrient balance studies performed on a subset (n = 15/30) of the infants randomly assigned to be fed formula with a P:E ratio of either 3.2 g/100 kcal or 2.6 g/100 kcal.Results:Despite the higher intake and net absorption of nitrogen by infants fed the higher P:E formula, there was no statistically significant difference in net nitrogen retention between groups. There also were no statistically significant differences between groups in digestible energy, metabolizable energy, energy expenditure, or energy storage. Thus, partitioning of stored energy as protein and fat did not differ between groups. The retention of calcium, phosphorus, sodium, potassium, copper, and zinc also did not differ between groups, and nitrogen intake did not affect mineral retention.Conclusions:In this study, formula for preterm infants with a P:E ratio of 3.2 g/100 kcal vs. 2.6 g/100 kcal provided no apparent benefit in terms of the proportion of fat to lean tissue accretion as determined from nutrient balance data.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Premature infants receiving alimentation with cow's milk formulas are at a considerably high risk of developing incipient late metabolic acidosis, an early stage in the development of manifest late metabolic acidosis. Is it possible to reduce this risk by modification of the composition of a standard formula?Methods:The mineral composition of a cow's milk preterm formula A was modified (formula B) with the aim of reducing the alimentary load to that of human milk. 160 premature infants were fed either mother's milk (n = 50) or the modified formula B (enriched with sodium and potassium) (n = 110), and their urine pH was tested twice a week. Randomly collected subgroups of infants were studied in detail for nutrient balances. The results were compared with earlier observations of 282 premature infants fed either mother's milk (n = 28) or the standard formula A (n = 254).Results:Incipient late metabolic acidosis was observed in nine of 78 premature infants receiving mother's milk, 53 of 254 premature infants receiving the standard formula A, and only one of 110 premature infants fed the modified formula B. Net acid excretion was 0.58 mmol/kg/day in 11 premature infants receiving alimentation with the modified formula B compared with 1.73 mmol/kg/day in 23 premature infants fed formula A. This reduction was mainly due to an increased alkali excess (sodium + potassium-chloride) in intake and urine.Conclusions:Reduction of renal acid load with the modified formula B had a preventive effect on the rate of development of incipient late metabolic acidosis in premature infants.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Nizatidine is an H2 histaminic receptor blocker, which acts on the oxintic cells in the stomach. The efficacy of nizatidine on acid gastric secretion has been widely studied in adults with erosive and ulcerative esophagitis, but not in children. The aim of the present study was to evaluate the therapeutic efficacy of nizatidine in children with reflux esophagitis.Methods:Twenty-six patients were studied; all of them underwent endoscopy with multiple esophageal biopsies and 24-h intraesophageal pH monitoring. The diagnosis of esophagitis was based on histologic features. Patients were randomly assigned to double-blind treatment with either nizatidine or a placebo (10 mg/kg/day in two doses) for 8 weeks. A symptomatic score assessment was evaluated during the study.Results:Twenty-four patients completed the 8-week protocol. After therapy, 9/13 (69%) patients on nizatidine and 2/13 (15%) patients on the placebo were healed (p < 0.007 by Fisher's exact test). Histological findings were improved in two other (16.7%) patients and unchanged in the last (8.3%) patient on nizatidine. In the placebo group there was histological improvement in three (25%) patients, no variation in six (50%), and worsening in one (8.3%). After therapy, determination of esophageal pH showed a statistically significant decrease of the total acid exposure time (p < 0.01) only in the nizatidine group. The clinical score analysis showed an improvement of symptoms only in the nizatidine group (p < 0.01), except for vomiting, which was reduced in both groups.Conclusions:Our results show that nizatidine is effective in treating children with reflux esophagitis. The children included in this study did not have severe esophagitis, and the conclusion must be limited to those with mild to moderate degrees of disease.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:In order to assess their long-term predictability for the diagnosis of celiac disease, antiendomysium antibody results were compared with the outcome of the Interlaken diagnostic process.Methods:Prospective gluten challenge was performed in 153 children with previously diagnosed flat small-intestine mucosa. In 90 patients (Group A), endomysium antibodies were initially positive, in seven (Group B) they were negative, and 56 patients (Group C) had no initial serological results. In IgA-deficient persons, IgG antibodies were also assayed, both by the immunofluorescent method.Results:Histological relapse rates were 100% (90/90), 14.3% (1/7), and 76.8% (43/56), p < 0.001, in Groups A, B, and C, respectively. Each patient with relapse also exhibited endomysium antibody positivity during the challenge. Patients in whom celiac disease could be finally ruled out remained consistently endomysium-antibody negative. The celiac disease patient in Group B had severe secondary immunoglobulin deficiency at entry, which explained the initial negativity. Diagnosis based on antiendomysium antibody positivity and flat mucosa gave a higher applicability (92.8 vs. 50.3%) and reliability (relapse rate 100 vs. 89.6%) than the 1990 European Society of Paediatric Gastroenterology and Nutrition (ESPGAN) criteria among these patients.Conclusions:Endomysium antibody positivity at presentation has been found to be as useful as gluten challenge in the diagnosis of celiac disease, even in patients under the age of 2 years. Challenge is still advisable in patients with a flat small intestinal mucosa when antiendomysium antibody results are negative or have not been done, as among these patients significantly lower relapse rates were found.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Cyclic vomiting is an uncommon disorder that can be described as recurrent, self-limiting, fairly uniform episodes of intractable nausea and vomiting with no identifiable organic cause, separated by symptom-free intervals. There is no established therapeutic regimen for this disorder.Methods:Fourteen children referred to the Pediatric Gastroenterology Clinic were diagnosed with cyclic vomiting from May 1984 to January 1995. Vomiting, the predominant symptom, was present in all children and was severe enough to require hospitalization in 11. Associated symptoms included abdominal ain, headache, nausea, aura, and fever. Diagnostic studies were done to rule out organic causes as indicated in individual patients. Daily phenobarbital was prescribed in all 14 patients. The dose ranged from 30 to 120 mg/hr (mean 2 mg · kg-1· day-1), with a median dose of 60 mg/hr. Prior therapy with propranolol (3 patients) and butalbital (2 patients) had been ineffective.Results:Eleven patients had complete resolution of their symptoms, and 3 patients had marked improvement in their symptoms with infrequent attacks of reduced severity. The only side effects associated with long-term phenobarbital therapy were behavioral in nature, namely hyperactivity and disruptive behavior at school.Conclusions:The results of our series of 14 patients, all of whom received barbiturates, support the usefulness of this therapeutic approach. Hence we feel that daily low-dose phenobarbital therapy is a safe and effective therapy in preventing episodes of cyclic vomiting in children.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID