ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryWe endeavored to determine the frequency and clinical characteristics of portal hypertensive gastropathy (PHG) in children with cirrhotic and noncirrhotic portal hypertension. Medical records of all patients with portal hypertension undergoing upper GI endoscopy during a 7-year period were retrospectively reviewed. PHG was defined as absent, mild, or severe by previously established criteria. Twenty-two patients with portal hypertension (17 cirrhotic, 5 noncirrhotic) were identified. In the group of 17 cirrhotic patients, PHG was noted in four at initial endoscopy (three mild, one severe) and in seven (two mild, five severe) during follow-up. Severe PHG was seen in one patient with noncirrhotic portal hypertension at presentation; in two patients, mild PHG developed during follow-up. In the 14 patients in whom PHG was noted, gastric mucosal disease developed in nine in whom no sclerotherapy was performed and in five patients treated with sclerotherapy. The size of varices, history of variceal bleeding, and presence or absence of hypersplenism did not appear to be related to the development of PHG. None of seven patients with mild PHG and two of seven patients with severe PHG bled from their gastric mucosa. We conclude that PHG is commonly observed in children with cirrhotic and noncirrhotic portal hypertension. Mild PHG appears to have little clinical significance, while severe PHG may cause bleeding. PHG may develop with or without sclerotherapy.

ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryWe performed 121 endoscopic retrograde cholangiopancreatographies (ERCPs) in 92 patients (60 girls and 32 boys), aged 4 months to 19 years, as part of diagnostic evaluation for suspected pancreatic or biliary tract disease or as therapeutic intervention. ERCP was successful in 116 attempts. The most common indications were recurrent pancreatitis (35 children), nonresolving acute pancreatitis (20), unexplained elevated amylase or lipase (19), postcholecystectomy syndrome (14), and elevated biliary tract enzymes (12). One hundred and one ERCPs were performed for more than one indication. The most common findings included chronic pancreatitis (26 cases), pancreas divisum (14), dilated pancreatic duct (10), gallstones or sludge (8), and abnormal common bile duct (8). Complications were uncommon and usually minor. ERCP is a safe and helpful procedure in the evaluation of suspected pancreatic and biliary tract disease in children and frequently allows for nonoperative treatment of these disorders.

ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryThe onset and course of ulcerative colitis diagnosed in 38 children at or before 10 years of age were reviewed. The mean age at onset was 5.9 years. A family history of inflammatory bowel disease was present in 24% of patients, and 13% had a history of cow milk allergy in infancy. Initially, by radiologic or colonoscopic studies, 71% had total colonic disease, 13% had left-sided colitis, and 6% had proctitis: extensive examination was not performed in 4 patients. Four patients (11%) presented with severe colitis. 14 (37%) with moderate colitis, and 20 (53%) with mild colitis. The most frequent symptoms were abdominal pain (94%), diarrhea (84%), and rectal bleeding (84%). Between 2 and 10 years after diagnosis, 89% of children had total colonic disease and 11% had left-sided disease. All four patients with severe disease at onset responded to medical therapy with one having a colectomy 15 years later with pathology consistent with Crohn's disease. Of those with moderate disease, half had infrequent moderate recurrences and half had intermittent mild disease. One patient had colectomy at 21 years for intractable disease. Of the 20 with mild disease, 16 continued to have intermittent mild recurrences, I had chronic mild disease. 2 had moderate recurrent disease, and 1 has remained asymptomatic for 5 years. Psychiatric disturbances requiring therapy were identified in 5 (13%) children. Results are encouraging: after the first 2 years of illness, two thirds of the children have had subsequent mild colitis with infrequent relapses and three quarters consider their life to be of good quality.

ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryThe safety and efficacy of olsalazine sodium was compared to sulfasalazine over 3 months in a multi-center, randomized, double-blind study of 56 children with mild to moderate ulcerative colitis. Twenty-eight children received 30mg/kg/day of olsalazine (maximum, 2 g/day) and 28 received 60 mg/kg/day of sulfasalazine (maximum, 4 g/day). Side effects were frequent in both groups. Eleven of 28 patients (39%) on olsalazine reported headache, nausea, vomiting, rash, pruritus, increased diarrhea, and/or fever. Thirteen of 28 on sulfasalazine (46%) reported similar side effects and/or neutropenia, and four patients had the drug stopped because of an adverse reaction. After 3 months, 11 of 28 (39%) on olsalazine were asymptomatic or clinically improved, compared to 22 of 28 (79%) on sulfasalazine (p = 0.006). In addition, 10 of 28 patients on olsalazine versus one on sulfasalazine required prednisone because of lack of response or worsening of colitis (p = 0.005). The dose of olsalazine used in this clinical trial was thought to be equivalent to a standard dose of sulfasalazine, but fewer patients on olsalazine improved and a greater number had progression of symptoms when compared to sulfasalazine. Although side effects were slightly less frequent for olsalazine, the number of patients was too small to detect a clinically significant difference.

ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryThis study was undertaken to determine the effect of reserpine on rat pancreatic growth, to evaluate if reserpine-caused alterations can be prevented by epidermal growth factor (EGF) and/or cerulein treatment, to evaluate the time course of rat pancreas recovery after reserpine, and to determine if EGF and/or cerulein treatment can accelerate such a recovery. In the first experiment, three groups of male Sprague-Dawley rats (250–265 g) were used. Ad libitum-fed control animals received the reserpine vehicle, and one experimental group received reserpine (1 mg kg-1day-1for 7 days) while the other, pair-fed group received the reserpine vehicle with a reduced amount of food to result in malnourishment. Rats from each of these three groups were also assigned to one of four treatments consisting of saline, EGF (10 μUg kg-1), cerulein (1 μUg kg-1), or a combination (same doses) twice a day for 7 days. In the morning of the 8th day, after an overnight fat, rats were killed. In the second experiment, rats were selected and treated with reserpine or the vehicle as described in experiment 1; after the 7-day treatment, a first cohort of animals was allowed a 30-day recovery period. Three other groups (an ad libitum-fed control, a pair-fed, and a reserpine group) were allowed a 6-day recovery period during which they were treated subcutaneously, twice a day, with either saline, EGF (10 μUg kg-1), cerulein (1 μUg kg-1), or a combination (same doses). On the morning of the 31st or 7th day, after an overnight fat, rats were killed. After death, all pancreata were examined for weight and protein, amylase, chymotrypsinogen, RNA, and DNA content. In the ad libitumfed control group, EGF caused pancreatic hypertrophy, whereas cerulein was associated with hypertrophy and hyperplasia. In the pair-fed malnourished group, the EGF effect was limited to slight increases in pancreatic weight and cell mass whereas cerulein caused hypertrophy; EGF plus cerulein caused pancreatic hyperplasia. In the reserpine group, EGF had no effect, whereas cerulein caused pancreatic hypertrophy and an increase in DNA content above the reserpine control. After 30 days of recovery, pancreata of pair-fed animals and those of rescrpine-treated animals were comparable with those of the ad libitum-fed control rats with the exception of amylase levels, which remained reduced in the reserpine group. After 6 days of recovery, the pancreata of the reserpine rats did not improve, but chymotrypsinogen content returned to ad libitum-fed control values. During the 6-day recovery period, total regeneration of the pancreatic tissue was observed in response to cerulein whereas EGF had no effect. In conclusion, modifications and alterations of the pancreatic tissue caused by reserpine and associated malnutrition can be prevented by cerulein, and cerulein remains the most potent factor to promote regeneration of the pancreatic gland after reserpine treatment and an episode of malnutrition.

ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryThe effect of orally administered epidermal growth factor (EGF) on the mucosal growth and hydrolase activity of normal and damaged small intestine was examined in rats. Adult rats fed EGF daily at 10 times the estimated daily intake of EGF from human milk showed increases in specific activity but not total activity of various brush-border hydrolases with unaffected mucosal protein content and villus-to-crypt ratios through day 9. Ingestion of EGF for 13 days resulted in significant decreases in mucosal protein content without changes in villus height or hydrolase activity. The effect of oral EGF on recovery of damaged intestine was studied in rats fed a liquid diet supplemented with EGF at 0, 1, 10, or 20 times the estimated daily intake from human milk after treatment with methotrexate (MTX) to induce acute intestinal injury. Animals treated with MTX showed significant reductions in body weight and small intestinal villus height, mucosal protein content, and hydrolase activities through day 6 posttreatment. Daily ingestion of EGF did not affect the MTX-induced reductions in mucosal protein content and hydrolase activity by day 3 but caused significant increases in mucosal disaccharidase and leucine aminopeptidasc activity by day 6 at the 1-or 10-times human milk EGF levels. Similar changes were not observed in MTX-treated rats fed the 20-times human milk level of EGF. These studies suggest that oral EGF is capable of modulating mucosal protein levels and stimulating entcrocyte hydrolase expression during repair of the intestinal mucosa.

ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryNeuronal intestinal dysplasia (NH>) of the colon has been reported in adults and children with chronic constipation. However, it is unknown whether these histological abnormalities are related to the severity of symptomatology or the findings of anorectal manometry. We studied 57 children (2 weeks to 17 years old, 33 boys) who had chronic constipation and/or soiling or obstructive symptoms early in life and evaluated anamnestic data, symptoms, outcome after 6 months of conventional therapy, rectal biopsies for signs of dysganghonosis, and results of anorcctal manometry. In cooperative patients, defeciaion dynamics were recorded during manometry with simultaneous surface electromyogram of the external anal sphincter. In 30 older patients, severity of constipation was assessed by measurement of colonic transit time with radiopaque markers. Histology confirmed Hirschsprung's disease in nine (excluded from further analysis), hyperganglionosis of the plexus submucosus (classic NID) in six, heterotopic ganglion cells without hyperganglionosis (abortive NID) in 18, and no signs of dysganglionosis in 24 patients. The rectoanal inhibitory reflex was more often absent or abnormal in children with classic NID (six of six) and abortive NID (11 of 17) compared with children with normal histology (four of 22) (p < 0.001). All other manometric parameters analyzed, colonic transit times, and clinical outcomes were not related to histological diagnosis. In contrast, the severity of constipation and outcome was significantly worse in children with abnormal defecation dynamics. These results suggest that histological signs of NID in the submucous plexus are of uncertain value in assessing the clinical picture and should not influence decisions concerning further treatment, especially surgical interventions.

ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryResistance to oral feedings occurring during the course of chronic gastroesophageal reflux (GER) in infants has received little attention in the literature. Accordingly, we reviewed the clinical courses of 600 infants of <24 months of age with GER seen over an 8-year period to determine the prevalence and course of this problem. After excluding infants with severe neurologic disease, craniofacial disorders, or a history of esophageal surgery, 25 infants were found to have resistance to oral feedings that was severe enough to warrant tube feedings for nutritional support. Sixteen of these 25 infants had a history of resistance to oral feeding antedating a diagnosis of GER, whereas nine developed resistance to feeding during the course of therapy. Gestational age, age at onset of GER symptoms, severity of GER, presence/severity of esophagitis, type of medical therapy, need for fundoplication, or postfundoplication complications were similar in these two groups. When the clinical records of these 25 infants were compared to an age- and sex-matched infant population with GER but without feeding resistance, no differences were noted in severity of GER or the presence/severity of esophagitis. However, failure to thrive and the need for fundoplication were significantly more common in the feeding resistance group (p < 0.001). Among those infants with neurodevelopmental evaluation, mild delay was seen more commonly in the infants with feeding resistance but fell short of statistical significance (p = 0.08). Our observations suggest that resistance to oral feedings is an uncommon but severe problem associated with GER in infancy. Future work will need to further characterize possible neurodevelopmental abnormalities or upper gastrointestinal dysmotility that might predispose patients to this type of feeding difficulty.

ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

SummaryChromium (Cr) dosage was assayed in i.v. nutrition, serum, and losses of five children on total parenteral nutrition for 4 weeks. The Cr supply (4.7 ± 1.2 μUg/kg/day) was above recommended levels (0.5 μUg/kg/day). Serum (18.2 ± 1.8 μUg/L) and urine (37.4 ± 10.5 μUg/L) were also higher than control values (0.7–0.9 μUg/L and 0.2–0.8 μUg/L, respectively). Serum and urine Cr concentrations displayed a positive correlation. Serum Cr and Fc showed a negative correlation. These results confirm the potential toxicity of Cr previously reported in animals. Cr levels of i.v. nutrition solutes should be checked thoroughly.

ISSN:0277-2116    

出版商:OVID    

年代:1993

数据来源: OVID