摘要:

Background:German pathologists have developed a consensus for histological features of intestinal neuronal dysplasia.Methods:A blind reevaluation of ganglionic suction rectal biopsies from infants and children who initially presented with symptoms of intestinal dysmotility was made.Results:84 of 411 specimens had sufficient depth of submucosa for adequate assessment. Questionnaires or clinical interviews were employed 3-5 years after biopsy in these 84 patients to assess the relationship between histological changes and persistent symptomology. Eighteen children were lost to follow-up, 4 others had Hirschsprung's disease the study biopsy specimen having been taken from the pulled-through bowel after surgical resection of the aganglionic segment. The remaining 62 patients were divided into three groups. There were six patients in group A (both obligatory criteria) and 28 in group B (nonessential, or just one of the obligatory criteria), and 28 in group C (normal appearances). On follow-up, two of the 28 (7%) in group B, and six of the 28 (21%) in group C had persistent dysmotility symptoms.Conclusions:Histological criteria of the consensus of German Pathologists for intestinal neuronal dysplasia was unhelpful in predicting the clinical outcome and therefore, should not influence clinical management. As one of the obligatory criteria, hyperplasia of the submucosal plexus was significantly more common in neonates (<4 weeks), it is concluded that this is an age-related variation.

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

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:The efficiency with which breast- and formula-fed infants utilize dietary nutrients is likely to provide insight into their relative requirements for the growth process.Methods:We measured longitudinal changes in growth, body composition, and dietary intakes in breast- and formula-fed infants and estimated the gross efficiency with which dietary nitrogen and energy were used for lean body mass and body fat deposition. Lean body mass and body fat were determined in 10 breast-fed and 10 formula-fed infants at 6-week intervals during the first 24 weeks of life by the18O dilution technique. Dietary nitrogen and energy intakes were determined from the amount of milk and food consumed and the nutrient content of the feedings. The gross efficiency of nutrient utilization was calculated for each infant from the cumulative dietary intake and the change in body composition with time.Results:Length and weight gains and lean body mass and body fat accretion during the first 24 weeks of life were similar between breast- and formula-fed infants despite significantly higher nitrogen and energy intakes of the formula-fed group. The gross efficiency of dietary nitrogen utilization for lean body mass deposition was almost two-fold lower in formula- than in breast-fed infants, whereas the efficiency of dietary energy utilization for lean body mass and body fat deposition was similar between groups. Despite apparent differences in the efficiency of nitrogen utilization, there was no association between lean body mass deposition and dietary protein intake, implying that human milk protein does not limit growth quantitatively in breast-fed infants.Conclusions:These differences in nutrient utilization illustrate the biologic adaptability of human infants who are quipped with mechanisms that promote normal growth despite the variability of their nutrient intake.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Thyroxine has been shown to play a role in the development of exocrine pancreatic enzymes in neonatal rats.Methods:To further evaluate the regulatory mechanisms for thyroxine in pancreatic development, we examined the changes in the expression of pancreatic enzymes (amylase and trypsinogen) and ornithine decarboxylase (ODC) genes following daily injection of thyroxine for 5 and 10 days to neonatal rats (5 days old).Results:Total pancreatic proteins and DNA contents as well as the activity of ODC and exocrine enzymes were significantly increased after 5 and 10 days of thyroxine treatment. These increases were associated with parallel alterations (to three to fourfold rise) in steady-state mRNA levels of both amylase and trypsinogen. In contrast, thyroxine only produced a 57-68% increase in steady-state ODC mRNA levels.Conclusions:These data suggest that thyroxine stimulated the express of amylase and trypsinogen genes partly due to increased transcriptional rate and/or decreased mRNA turnover. Thyroxine also stimulated ODC gene expression. However, the stimulatory mechanisms may involve transnational or posttranslational regulation of ODC and are independent of thyroxine effects.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:α-Interferon is widely accepted for treatment of adults with chronic hepatitis B, but its use remains limited in children, partly because of questions regarding its cost effectiveness. The aim of this study was to evaluate the cost effectiveness of α-interferon for children with chronic active hepatitis B.Methods:We estimated the cost per year of life saved by α-interferon therapy for three cohorts of patients with chronic active hepatitis B treated at 2, 12, or 25 years of age. We assumed that only patients with active viral replication would be treated and that α-interferon would prevent cirrhosis and hepatocellular carcinoma in a portion of the population treated. We calculated costs per year of life saved. Medical costs and years of life saved were discounted at 5% per year.Results:With a 30% response rate to α-interferon, there was a net savings in both money and lives in the children's group with a minimal cost per year of life saved for adolescents ($510) and adults ($934). Years of life saved per person were greater for children (1.0) than adults (0.5). With a 6% response rate, estimated costs per year of life saved for children ($5,700) were one-fourth of those of adults ($22,100).Conclusions:α-interferon therapy for patients with chronic active hepatitis B is cost effective. α-Interferon is more cost effective in toddlers than adults because of the smaller dose required and the greater increase in life expectancy of children.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:The use of large-volume electrolyte balanced solutions as preparation for colonoscopy often results in poor patient compliance and acceptance. The tolerance, safety, and efficacy of high-versus low-volume colon-cleansing methods as preparation for colonoscopy in children were compared by randomized operator-blinded trial.Methods:Twenty-nine children ages 3.6-14.6 years had either high-volume nasogastric balanced polyethylene glycol electrolyte lavage (20 ml/kg/h) until the effluent was clear (n = 15), or two oral doses of sodium phosphate solution (22.5-45 ml) separated by oral fluid intake (n = 14).Results:Both preparations were equally effective. The low-volume preparation was better tolerated and caused less discomfort that the high-volume preparation, judging by serial nurse observations. The incidence of abdominal symptoms, diarrhea, sleep disturbance, and vomiting was not significantly different between the two groups. Both groups had a small reduction in mean hematocrit and serum calcium levels. The sodium phosphate preparation caused increases in mean serum sodium concentrations from 140 to 145 mmol/L and serum phosphate concentrations from 1.41 to 2.53 mmol/L. Ten hours after the commencement of the preanesthetic fast, these concentrations had returned to normal.Conclusions:There are advantages in terms of tolerance, discomfort, and case of administration with acceptable colonic cleansing with the use of the less-invasive oral sodium phosphate low-volume colon-cleansing preparation in children. Safe use requires ensuring an adequate oral fluid intake during the preparation time and avoidance of use in patients with renal insufficiency.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Women who return to work outside of the home while still breastfeeding must often store the expressed milk at less than optimal temperatures. Human milk provides digestive enzymes (amylase and lipase) that compensate in the newborn for immature pancreatic function.Methods:We have assessed the stability of amylase and bile salt-dependent lipase after storage for 1-24 h at 15, 25, and 38°C.Results:Both enzymes were stable at 15 and 25°C for 24 h, whereas at 38°C there was a 15 and 20% decrease in lipase and amylase activity, respectively. The stability of milk lipoprotein lipase was also tested. This very labile enzyme was more stable in milk than previously reported for blood and tissues, i.e., 20 and 50% decrease in activity after storage at 15 or 25°C for 24 h, respectively. A two-unit drop in milk pH by 24 h of storage would not affect the activity of digestive enzymes, which are stable at pH >3.5.Conclusions:We conclude that milk provides the same compensatory digestive activity after short-term storage, even at relatively high temperature, as when fed fresh to the infant.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Background:Reports concerning nonsyndromic paucity of the interlobular bile ducts are not common.Methods:The clinical, biochemical, and histological features of ten such children were described.Results:All presented with jaundice, starting in the first month in seven and in the fourth, seventeenth, and thirtieth month in the others. Acholic stools were present intermittently in seven and persistently in three patients. Pruritus was a prominent symptom in five. Liver function tests were abnormal in all but one. Liver biopsies were performed at ages of 20 days to 3 years (median 5 months). In addition to a paucity of interlobular bile ducts, histology revealed intracellular cholestasis in all, portal fibrosis in four, and regenerative nodules in two patients. Complications of fat-soluble vitamin deficiency occurred in seven. Therapy consisted of supplementation of those vitamins and administration of cholestyramine, phenobarbital, prednisolone, or ursodeoxycholic acid. While one child had a successful orthotopic liver transplantation, three died. Consanguinity rate was 80% among the parents, and five of the patients had siblings with similar symptoms.Conclusions:Prognosis of these patients is variable. Differentiation from other forms of cholestasis is important especially to avoid surgery.

ISSN:0277-2116    

出版商:OVID    

年代:1997

数据来源: OVID