ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundVariability of symptoms and signs make the diagnosis of children's food allergy (FA) difficult. In addition, mechanisms and antigens involved vary with age. In young infants, cow's milk protein allergy is associated with an increase of cytotoxic intraepithelial lymphocytes (IELs) expressing T-cell–restricted intracellular antigen (TIA1). In the current study, the significance of TIA1 in FA in older children of mainly preschool and school age was analyzed and the findings correlated the with a detailed clinical, endoscopic, and histopathologic analysis.MethodsThe subjects of this study were 66 children (mean age, 7.9 years; range, 1–15), including 27 with untreated and 15 with treated FA, and 24 control subjects. The morphology of duodenal and antral biopsy specimens was evaluated, and the proportion of TIA1-positive IELs was counted from immunostained sections. Quantification of mast cells with immunostaining for mast cell tryptase (MCT) was completed, with the estimation of diffuse extracellular staining considered to indicate degranulation.ResultsPatients with untreated FA showed an increase in the total number of TIA1-positive cells and IELs and of the TIA1/IEL ratio. The number of mast cells in duodenal mucosa was decreased in children with FA, but no association with degranulation was observed. Endoscopic abnormalities were common in FA, but conventional histopathology showed no informative differences.ConclusionsThe significant increase of TIA1-positive IELs in duodenal tissue specimens is associated with FA. The cytotoxicity of T lymphocytes seems to play a role in the pathogenesis of gastrointestinal FA. Activation and mechanisms of action should be studied further.

ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundHyperimmunized bovine colostrum containing antibodies has been shown to be effective in the treatment of rotavirus diarrhea. Antibodies derived from eggs of immunized hens may be a less expensive and more practical alternative. In this study, children with proven rotavirus diarrhea were treated with immunoglobulin extracted from eggs of chicken immunized with human rotavirus strains.MethodsIn a randomized, double-blind study, 79 children with known rotavirus diarrhea were assigned to receive either 10 g hyperimmune egg yolk (HEY) daily in four equally divided doses for 4 days (HEY group) or a similar preparation obtained from nonimmunized chicken (placebo group). The daily stool frequency and amount, oral rehydration solution (ORS) intake, and presence of rotavirus in the stool were monitored for 4 days.ResultsIn the HEY-treated group. there was significant reduction in stool output (in grams per kilogram per day; HEY vs. placebo; 87 ± 59 vs. 120 ± 75,P= 0.03), and significant reduction of ORS intake (in milliliters per kilogram per day) (HEY vs. placebo; 84 ± 46 vs. 122 ± 72,P= 0.008) on day 1 and clearance of virus on day 4 (HEY vs. placebo; 73% vs. 46%,P= 0.02). There was, however, no difference in diarrheal duration between the groups.ConclusionsTreatment with HEY against four human rotavirus strains resulted in modest improvement of diarrhea associated with earlier clearance of rotavirus from stools. These results indicate an encouraging role of HEY in the treatment of rotavirus-induced diarrhea in children. Further studies are needed to optimize the dose and neutralization titer and thus improve the efficacy of egg yolk immunoglobulin IgY derived from immunized hens.

ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundAlthough the dissociative sedative ketamine is used commonly for pediatric procedural sedation in other settings, the safety of this agent in pediatric gastroenterology is not well-studied. A 5-year experience with ketamine sedation for pediatric gastroenterology procedures was reviewed to document the safety profile of this agent and to identify predictors of laryngospasm during esophagogastroduodenoscopy (EGD).MethodsThe study was a retrospective consecutive case series of children receiving ketamine administered by pediatric gastroenterologists skilled in basic airway management to facilitate pediatric gastrointestinal procedures during a 5-year period. Patient's records were reviewed to determine indication, dosage, adverse effects, drugs, inadequate sedation, and recovery time for each sedation. A multiple logistic regression analysis was performed to identify predictors of laryngospasm during EGD. Outcome measures were descriptive features of sedation, including adverse effects and predictors of laryngospasm during EGD.ResultsDuring the study period pediatric gastroenterologists administered ketamine 636 times, primarily for EGD (86%) and primarily by the intravenous route (98%). The median loading dose and total dose were 1.00 mg/kg and 1.34 mg/kg, respectively. Inadequate sedation was noted in seven (1.1%) procedures. Adverse effects included transient laryngospasm (8.2%), emesis (4.1%), recovery agitation (2.4%), partial airway obstruction (1.3%), apnea and respiratory depression (0.5%), and excessive salivation (0.3%). There were no adverse outcomes attributable to ketamine. Nearly half (46%) the subjects had severe underlying illness (American Society of Anesthesiologists [ASA] class ≥3). All instances of laryngospasm occurred during EGD (9.5% incidence), and the only independent predictor of laryngospasm in this sample was decreasing age. The incidence of laryngospasm was 13.9% in preschool-aged (≤6 years) children and was 3.6% in school-aged (>6 years) children (difference 10.3%, 95% confidence intervals 5.5–14.9%). No dose relationship was noted with laryngospasm, and the risk did not increase with underlying illness.ConclusionPediatric gastroenterologists skilled in ketamine administration and basic airway management can effectively administer this drug to facilitate gastrointestinal procedures. Transient laryngospasm occurred in 9.5% of children receiving ketamine for EGD, and its incidence was greater in preschool than in school-aged children.

ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundThe high prevalence of low nocturnal blood glucose levels is a major problem in the treatment of children with diabetes.MethodsThe effect of a &bgr;-glucan–enriched bedtime snack on nocturnal blood glucose levels was examined in comparison with an equicaloric conventional snack in 38 children with diabetes during a 12-night study period.ResultsA significant influence of the type of bedtime snack on the blood glucose course until 2 AM could be observed (P< 0.05). However, there was no difference in the prevalence of nocturnal hypoglycemic blood glucose levels, which was 27% at 2 AM.ConclusionSilent nocturnal hypoglycemia is common in children with diabetes. The introduction of a fiber-enriched bedtime snack may flatten the blood glucose curve before midnight but cannot prevent low 2 AM blood glucose. Other therapeutic strategies that reduce the risk of asymptomatic and symptomatic nocturnal hypoglycemia would be beneficial to many children with diabetes.

ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundSymptomatic hypoglycemia is an unavoidable problem in the treatment of type I diabetes. Celiac disease is associated with malabsorption and may therefore represent an important risk factor.MethodsThe frequency of symptomatic hypoglycemia in patients with type I diabetes and celiac disease (cases) was compared with those of patients who had diabetes without celiac disease (controls). For this purpose, each case was matched for age, sex, and duration of disease with one to two control patients. Indices of metabolic control (hemoglobin [Hb]A1c, frequency of hypoglycemia, and total insulin requirement) were retrieved for the 18 months before and after diagnosis of celiac disease.ResultsEighteen patients (6 males and 12 females) had diagnosed celiac disease and were matched with 26 control patients (10 males and 16 females). There was no difference in age (11.0 years; range, 1.8–21.9 vs. 13.1 years; range, 2.3–22;P= 0.3) and duration of disease (8.4 years; range, 1.2–19.3 vs. 8.3 years; range, 1.1–18.7;P= 0.3) between the two groups. During the 6 months before and after diagnosis of celiac disease the cases had significantly more hypoglycemic episodes than the controls (means ± SD; 4.5 ± 4 vs. 2.0 ± 2.2 episodes/months,P= 0.01). This was reflected by a progressive reduction in insulin requirement over the 12 months before diagnosis reaching a nadir at time 0 (0.6 ± 0.2 vs. 0.9 ± 0.3,P= 0.05).ConclusionThese data suggest that underlying celiac disease is associated with an increased risk of symptomatic hypoglycemia and that the introduction of a gluten-free diet with normalization of the intestinal mucosa may reduce its frequency.

ISSN:0277-2116    

出版商:OVID    

年代:2001

数据来源: OVID