摘要:

Verotoxin-producingE. coli(most frequentlyE. coli0157) have been implicated in the pathogenesis of diarrhea, hemorrhagic colitis, hemolytic uremic syndrome and thrombotic thrombocytopenic purpura. Cattle, meat products, and other sources have been found to harbor these organisms. Isolation ofE. coli0157:H7 on MacConkey-sorbitol agar is diagnostic, yet the bacteria are difficult to detect after the first week of infection. Enzyme linked immunosorbent assays (ELISAs) can detect verotoxin in fecal filtrates in the absence of viable bacteria. Serologic evidence has also been used to support the diagnosis of verotoxin-associated infection. Evidence supporting the etiologic role of different verotox-ins is reviewed. Treatment remains supportive since the use of antibiotics and antimotility agents can lead to poorer outcomes. Recommendations for prevention are presented.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In 1983 we assessed the implications for hepatic transplantation programs by studying mortality from liver disease in a tertiary care children's hospital. The current study reviews the impact of orthotopic liver transplantation (OLT) on survival for the period 1984–1989. Findings showed that deaths from liver disease decreased from 9.2 to 3.8 per year. Twenty-eight infants and children were referred and underwent OLT, with a 64% survival rate. Deaths from biliary atresia, which used to account for 24% of the total, have been reduced to 4.3%. Deaths from liver failure in infancy (which decreased from 49% to 39%) still present formidable challenges for transplantation. The implications of these findings are discussed.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In this prospective study, neonates with clinical congenital syphilis were investigated to determine if penicillin therapy caused a deterioration in liver function. The relationship between circulating immune complexes and liver involvement was monitored, and the efficacy of steroid therapy as an adjunct in the treatment of congenital syphilis was investigated. Thirty neonates with clinical congenital syphilis were randomly assigned into two groups: one group received penicillin therapy only, and the other group penicillin and prednisone as an adjunct. Twenty-one infants who did not have clinical or serological syphilis, born to seropositive mothers, served as a “control” group. Liver function tests, full blood counts, and immunological studies were performed at various intervals up to 3 months of age. Although the symptomatic groups differed significantly from the asymptomatic group in most of the parameters measured, there were no significant differences noted between the two symptomatic groups at any time point. No direct relationship between penicillin therapy and either deteriorating liver function or the presence of circulating immune complexes could be demonstrated. Also, prednisone therapy did not modify any of the parameters studied.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The authors studied serum neopterin in 106 patients with β thalassaemia major. A good correlation was found between neopterin values and glutamic pyruvic transaminase (GPT) mean values of the last 6 months, whereas no correlation was found between neopterin values and some siderosis indexes (iron/body weight, total accumulated iron). A statistically significant correlation was found between neopterin values (>10 nM/L vs. < 10 nM/L) and histological liver findings (chronic hepatitis vs. siderosis). Neopterin values were also statistically different between splenectomized and not splenectomized patients. Moreover serum neopterin was higher in HCV-Ab positive than in HCV-Ab negative patients, and 91.6% of the HCV-Ab positive group also showed histological signs of chronic hepatitis. These data suggest that increased serum neopterin might help to identify chronic C hepatitis in thalassaemic patients.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

From January 1984 through August 1986, 130 infants were referred to our department with a history of apnea, hypotonia, and cyanosis or pallor, suggesting near-miss sudden infant death syndrome. Protocol consisted of medical history, clinical examination, overnight polygraphic recording, and cardiologic, gastrointestinal, metabolic, neurologic, and toxicologic workups. In 49 of these infants who needed vigorous stimulation or mouth to mouth resuscitation, the event occurred shortly after feeding. Combined, continuous esophageal pH monitoring and polygraphic recording in these 49 infants showed pathologic gastroesophageal reflux (GER) in 34 patients. An abnormal overnight polygraphic recording was observed in 8 of 34 infants with pathologic GER. Other investigations led to etiologic diagnoses in 42 of the remaining infants. Severe GER was frequently found in children with apnea after feeding but clearly is not the only mechanism involved. Infants with a history of apnea after a feeding should be investigated for GER and appropriately treated.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

In 18 low birth weight infants, small for gestational age, with different degrees of intrauterine growth retardation the activities of pancreatic lipase and trypsin and the concentrations of bile acids were measured in preprandially aspirated duodenal juice. The results were compared to those of 24 low birth weight infants, appropriate for gestational age, with comparable birth weights and postnatal ages. The activities of both measured pancreatic enzymes were negatively correlated with the degree of intrauterine growth retardation, expressed as the difference between the individual birth weight and the weight of the 10th percentile of the intrauterine growth curve (lipase:r= −0.697, p < 0.001; trypsin:r= −0.739, p < 0.001). The activity of trypsin in the small for gestational age infants was within the range of that found in the infants appropriate for gestational age. However, the lipase activity was decreased in infants who presented with growth retardation of >400 g/kg birth-weight. The concentrations of bile acids were similar in both groups (4.60 ± 2.51 and 4.55 ± 2.26 mmol/L, respectively) and sufficient for activating the bile salt stimulated lipase in human milk. The data suggest that in intrauterine growth retarded infants the lipase activity in the duodenal juice can be a limiting factor for optimal fat digestion. This should be considered in the nutritional management of such infants.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The vitamin D dependent intestinal calcium-binding protein (calbindin-D9K) was measured by an enzyme-linked immunoadsorbent assay in small intestinal biopsy specimens from 10 children (aged 15–126 months). The aim was to study the relationship between calcium-binding protein and age, bone age, and height. The patients were examined due to complaints of chronic diarrhea, but no evidence of malabsorption was found. The amount of calbindin-D9Kper mg of soluble protein in the small intestinal biopsy specimens was higher than previously studied in normal adults. Calbindin-D9Kcorrelated inversely with chronological age, bone age, and height of the children (p = −0.87, p = −0.66, and p = – 0.66; p < 0.05). A direct correlation was found between calbindin-D9Kand intestinal alkaline phosphatase activity (p = 0.60; p < 0.05). The decline in calbindin-D9Kmay indicate that the active vitamin D dependent intestinal calcium absorption decreases during childhood.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To determine the relationship between infantile colic and cow's milk protein intolerance (CMPI) in formula-fed infants, 70 infants (38 male, 32 female) were selected, with mean age 30.2 ± 21.4 days, with severe colic (duration of crying >4 h per day for 5 days per week). In 50 of the infants in the study group (71.4%) there was a remission of symptoms when cow's milk protein (CMP) was eliminated from the diet. Two successive challenges caused the return of symptoms in all these 50 infants. There was a positive anamnesis for atopy in 9 of 50 of the patients with CMP-related colic and in 1 of 20 of those with non-CMP-related colic (p > 0.05). A follow-up period of 18 months' mean duration showed that 22 of 50 (44%) of the infants with CMP-related colic and 1 of 20 (5%) of those with non-CMP-related colic developed an overt alimentary intolerance (p < 0.02). We conclude that a considerable percentage of the infants with severe colic also have CMPI and that in these cases, dietetic treatment should be the first therapeutic approach

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Indium-Ill leukocyte scanning and colonoscopy were performed in 19 children and adolescents with chronic inflammatory bowel disease to study the correlation of evaluation between these two diagnostic modalities in comparison to histologic study for colonic disease. Seven patients had ulcerative colitis, 10 had Crohn's disease, and two patients had no specific diagnosis after evaluation. The sensitivity of indium-Ill scan was 18%, specificity was 62.5%, and accuracy for diagnosing colonic disease was only 37%. In comparison, sensitivity and specificity for colonoscopy were 100 and 57%, respectively. Furthermore, accuracy with colonoscopy was 84%. Our data suggest that the usefulness of scans is limited to patients in whom standard diagnostic procedures are contraindicated. In addition, it is essential to confirm the visual diagnostic impression on colonoscopy with histologic study.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A randomized, double-masked clinical trial was completed to compare the effects of four dietary regimens for the nutritional management of 116 Peruvian children between 3 and 24 months of age with acute diarrhea. Diets consisted of a modified whole milk formula (group M), a lactose-hydrolyzed milk formula (HM), wheat noodles and whole milk (N-M), or wheat noodles and lactose-hydrolyzed whole milk (N-HM), all offered in amounts up to 55 kcal/kg body weight/day for the first 2 days of treatment and up to 110 kcal/kg/day for 4 days thereafter. The clinical characteristics of the patients in each group were similar initially. Treatment failure rates in the two milk groups combined (M = 14.3%, HM = 20.0%) were greater than in the two noodle-milk groups combined (N-M = 3.4%, N-HM = 3.4%), p = 0.03. The average stool outputs by children in both M groups (range 40–66 g/kg body weight per day on all study days) were consistently greater than those by children in both N-M groups (range 29–50 g/kg/day). The differences by dietary group were statistically significant on days 3 and 4 (p < 0.04, analysis of variance). The estimated median durations of illness [and 95% confidence limits (CL)] in each milk group (M = 138 h, CL: 88–214; HM = 113 h, CL: 75–170) were significantly greater than in each noodle-milk group (N-M = 52 h, CL: 35–76; N-HM = 67 h, CL: 45–100), p < 0.001–0.071. In this group of patients, noodle-milk mixtures produced fewer treatment failures, lower fecal outputs, and shorter durations of diarrhea than did milk alone, regardless of the lactose contents of the respective milks or mixed diets. Small differences in intestinal absorption and changes in body weight by dietary group that were identified were of minor clinical importance during the short duration of study. Thus, the noodle-milk diets employed during this study were safer than the milk diets for the dietary management of children with acute diarrhea.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID