ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The clinical usefulness of serum γ-glutamyl transpeptidase (γGT) assay for the diagnosis of liver disease in children was assessed retrospectively in 398 children investigated from 1981 to 1986, in whom diagnosis was ascertained according to currently accepted criteria including liver histology in each case. Serum γGT activity was within normal limits in 10 controls, in 19 children with portal vein obstruction, and in 10 of 12 children with congenital hepatic fibrosis. Serum γGT was raised in all children with biliary atresia, sclerosing cholangitis, paucity of interlobular bile ducts, and α1-antitrypsin deficiency with jaundice. Serum γGT was normal in spite of patent clinical signs of cholestasis in 3 patients with benign recurrent intrahepatic cholestasis, 1 infant with posthemolytic neonatal cholestasis, and in 22 of 28 patients with progressive idiopathic cholestasis akin to Byler disease. In the latter group, children with raised serum γGT displayed extensive portal fibrosis and bile duct proliferation on liver histology, while this was not a prominent feature in children with normal serum γGT. These results indicate (a) the value and limits of the assay for serum γGT activity in children with liver disease, (b) that raised serum γGT may be considered a fairly reliable index of bile duct damage, and (c) that serum γGT may prove a useful tool in separating two forms of progressive idiopathic cholestasis, with or without bile duct involvement.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Changes in serum α-fetoprotein (αFP) levels were investigated by radioimmunoassay during the follow-up (17 ± 12 months, two to three times per year) of 50 children with chronic hepatitis B virus infection (mean age of 8 years, 30 males) and of 35 healthy age- and sex-matched controls. Eleven of 50 were healthy carriers; 7 had chronic persistent hepatitis, 29 had chronic active hepatitis, and 3 had cirrhosis-associated chronic active hepatitis. Serum αFP levels in controls were found to be always lower than 5 ng/ml (0.1–4.4 ng/ml, x ± SD of 1.34 ± 1.32 ng/ml). Statistical analysis after logarithmic transformation showed a significant difference between mean levels (ng/ml) in controls and in patients [geometric mean = 0.83 C.L. (95% confidence limits of 1.19/0.58) vs. 3.43 (95% C.L. of 4.79/2.45);p= 0.0001]. Mean values of serum αFP levels at entry were higher than those found at the end of the follow-up period [geometric mean = 3 (95% C.L. of 4.69/1.92) vs. 1.48 (95% C.L. of 2.13/0.95);p= 0.038]. Only three patients repeatedly showed high αFP levels (76.7, 122.8, and 1,600 ng/ml at entry): αFP values became normal after a mean follow-up of 17 ± 7.8 months as well as liver enzymes, with no changes in serum “e” antigen-antibody and anti-delta antibody status being observed. Mean values of serum αFP levels in HBeAg-positive patients were significantly higher than in HBeAg-negative patients both at entry and during the follow-up (p= 0.05). Serum logarithmic αFP values were significantly correlated with log aminotransferases (alanine aminotransferase:r= 0.38 andp< 0.0001; aspartate aminotransferase:r= 0.36 andp< 0.0001) and log γ-glutamyl transpeptidase (r= 0.32 andp< 0.0001). Although serum αFP levels were found to be higher in patients with the most severe histological damage, they did not allow the accurate discrimination of histological categories in individual patients.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Variceal sclerotherapy has been performed in the pediatric population, but techniques and dosages of sclerosant recommended in the literature are largely empirical. Having accumulated much data through experience with sclerotherapy in children, we have identified patient and procedure variables associated with early and late complications. We reviewed our experience with 37 pediatric patients, ages 1–18, who underwent 150 sclerotherapy sessions. Sclerotherapy was associated with 12 early complications in 11 patients. Early complications were bleeding (five), respiratory problems (three), false channel formation (two), and gross hematuria (two). Four patients developed strictures. We identified the following variables associated with complications: for bleeding, platelet count <100,000/mm3; for respiratory complications and false channel formation, weight <12 kg; for false channel formation, dosage of sclerosant/kg/session > 1.75 ml/kg; for gross hematuria, total sclerosant/session >20 ml. A need for more than six sclerotherapy sessions for obliteration of varices was associated with a greater frequency of stricture formation. Sclerotherapy can be performed safely in children. Patients <12 kg or with platelet counts <100,000/mm3should be monitored carefully for respiratory complications and postprocedure bleeding. Sclerosant dosages >1.75 ml/kg, or 20 ml total sclerosant, should be given with caution.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Infants and children undergoing upper intestinal endoscopy were monitored by both pulse oximetry and chest EKG. Fifty-seven patients between the ages of 6 weeks and 36 months underwent 60 flexible upper intestinal endoscopies. All patients received parenteral sedation only. All procedures were successfully performed without significant complications. In 53 of the patients there was only transient mild oxygen desaturation with introduction of the endoscope into the pharynx and upper esophagus. In contrast, in seven patients, oxygen desaturation to less than 90% was noted following sedation but prior to insertion of the endoscope without overt clinical evidence of complications. Oxygen administered by nasal cannula resulted in a return of the oxygen saturation to at least the preprocedural level and allowed for safe completion of the studies. With improved monitoring, the use of smaller, more flexible endoscopes, and more experience, routine general anesthesia in children <3 years of age, as recommended in the past, may not be mandatory. Pulse oximetry may be particularly useful as an early indicator of poor oxygenation and may provide an objective means to assess the need for supplemental oxygen and to determine the degree of postprocedural observation.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Twenty-nine infants (2–4 months old), with pathological gastroesophageal reflux assessed by 24-h esophageal pH monitoring, were studied. Cisapride or placebo was randomly added to positional treatment, prone-antiTrendelenburg position, which was applied to all infants. The pH monitoring was repeated after 13–16 days of treatment and revealed a significant improvement in both groups for most parameters. But the number of reflux episodes lasting longer than 5 min and the total number of reflux episodes had not decreased significantly in the placebo group. Only in the number of reflux episodes lasting longer than 5 min was improvement during treatment significantly greater in the cisapride group. This suggests cisapride both prevented reflux and improved esophageal clearance. These results suggest that in addition to other therapeutic measurements, such as positional treatment (which was previously demonstrated to be effective in this age group), cisapride might be of benefit in the treatment of gastroesophageal reflux disease.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To facilitate the detection of postcibal gastroesophageal reflux (GER), we have constructed an infant formula from modular carbohydrate, fat, and protein components with a pH of 4 and a nutrient composition identical to standard infant formula, in comparison to standard infant formula and sugar solutions, this pH-adjusted formula demonstrates a significantly greater amount of gastroesophageal reflex during the first postcibal hour. We speculate that the greater caloric density and slower gastric emptying of regular infant formula promotes greater gastroesophageal reflux than is observed with regular dextrose feedings. This effect is obscured unless the pH of the formula is adjusted. Use of this weakly acid formula in conjunction with postcibal esophageal pH probe recording facilitates the detection and, during simultaneous apnea monitoring, potential association of symptoms with postcibal gastroesophageal reflux.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Sixteen patients with asthma and chest pain of >2 months duration underwent gastroenterological evaluation utilizing fiber-optic esophagogastroduodenoscopy (EGD), esophageal manometry, and Bernstein testing. Eleven of 16 patients (75%) had endoscopic and histologic evidence of esophagitis. One patient with esophagitis exhibited high-amplitude peristaltic contractions during motility testing. Four of these 11 patients (36%) had a positive Bernstein test. Extended intraesophageal pH monitoring of seven patients with esophagitis revealed significant gastroesophageal reflux (GER) in all of these patients. Chest pain was associated with an episode of GER in three patients (43%). Nine of 11 patients (82%) with esophagitis responded to medical therapy, resulting in resolution of esophageal inflammation and chest pain. One patient required Nissen fundoplication surgery after failure of medical therapy, and one patient who refused surgery progressively developed more severe esophagitis during 9 months of medical therapy. Children with asthma may have chest pain due to gastroesophageal reflux-associated esophagitis that usually responds to medical therapy.

ISSN:0277-2116    

出版商:OVID    

年代:1991

数据来源: OVID