ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We analyzed retrospectively the effect of immunosuppressive therapy in 139 children with HBsAg-positive chronic active hepatitis (CAH) observed in four liver units in Italy from 1974 to 1982. All children had been observed for at least 12 months. Of these 139 patients, 38 were treated with steroids (prednisolone or prednisone from 1 to 2 mg/kg daily), 78 with combination therapy (prednisolone or prednisone 1 mg/kg daily in combination with azathioprine, 2 mg/kg daily) and 23 were not treated. The outcome of the disease was assessed by evaluating clinical, biochemical, and histological parameters on the basis of preselected criteria. Untreated patients deteriorated more frequently than those treated with steroids (34.8% versus 13.2%, p < 0.05) or those receiving combination therapy (34.8% versus 10.3%, p < 0.01). Remission or improvement was observed more frequently in steroid-treated and combination-treated patients than in the untreated ones (p < 0.001 and p < 0.01, respectively). At the end of the study, only one untreated patient had died of liver failure. Remission was observed in about 10% of patients in the two groups of treatment, but in the untreated one, this event never occurred. Although this study is retrospective and presents some shortcomings, the data clearly indicate that steroid and combination therapy are not deleterious, and are possibly helpful, to children with HBsAg-positive CAH. Considering that this treatment clearly ameliorates the course of the disease in some patients, and that no other treatment has been conclusively demonstrated to be efficient in favorably modifying the course of the illness, we suggest that prednisolone alone or in combination with azathioprine still be considered for treating children with severe HBsAg-positive CAH without cirrhosis.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A prospective study of acute symptomatic viral hepatitis in childhood was started at the Department of Infectious Diseases of Padua (Italy) in 1978. During an 8-year period, 93 consecutive patients (aged 3 months to 12 years) fulfilled the diagnostic criteria, including five (5.5%) cases classified as non-A, non-B hepatitis. This figure is lower than that generally reported in adult patients, probably because of a lower exposure of children to blood and contaminated materials. Two of the five children with non-A, non-B hepatitis had received blood transfusions, while three had no history of parenteral exposure. Although the outcome of the illness was favorable in all five patients, a variety of clinical features could be observed: two children had a mild, short-lasting disease, anicteric in one case, while three had a polyphasic pattern of transaminases with delayed biochemical resolution, including one patient with deep jaundice and severe early phase features. These findings suggest that in children, as well as in adults, non-A, non-B hepatitis is probably a heterogeneous entity induced by different agents with different modes of transmission.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Bilirubin production, as indexed by serum carboxyhemoglobin (HbCOc), was studied in a group of normal term Japanese infants and Caucasian controls during the second to third day of life. Stringent entry criteria were employed in order to eliminate infants with hemolysis or other known causes of increased bilirubin production. The mean HbCOcof the Japanese infants (0.69 ± 0.15% sat) was significantly higher than that of the Caucasian infants (0.58 ± 0.17% sat). The serum total bilirubin was also significantly higher in Japanese infants (11.1 ± 3.0 mg/dl versus 8.0 ± 2.2 mg/dl). This difference may be attributable to environmental and/or genetic factors.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Fecal bile acid patterns and concentrations have been determined for 28 infants who were followed from average ages of 3–11 months. Half were solely breast-fed and half were solely formula-fed at the beginning of the study. Breast-fed infants were found to have significantly (p < 0.05) lower concentrations of cholic acid than the formula-fed group, up to an average age of 5 months. Concentrations of deoxycholic and lithocholic acids were directionally lower in breast-fed infants at all ages. Concentrations of chenodeoxycholic acid were similar for both groups throughout the study. At the end of the study, breast-fed infants were excreting 17% of their total bile acids in the form of secondary acids, compared to 33% for formula-fed infants. This pattern persisted long after the infants began weaning. Formula-fed infants were found to have lithocholic acid in their stools at a significantly (p < 0.05) earlier age than breast-fed infants. Appearance of deoxycholic acid was at similar ages for both groups. Both of these secondary acids were found to occur at much younger ages (approximately 2 months) than has been previously reported. These observed differences are attributed to the distinct intestinal microbial populations encouraged by the different diets.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We report two sisters with neonatal hemochromatosis (NHC), including the first documented survivor. Characterized by excessive parenchymal iron in liver, pancreas, heart, and other organs, but little iron in the spleen, bone marrow, or other sites of the reticuloendothelial system, NHC is rarely reported and has been uniformly fatal. The first infant (case 1) presented with neonatal hypoglycemia, coagulopathy, and mild hyperbilirubinemia; she rapidly deteriorated and died of multisystem failure. Autopsy showed cirrhosis. Her sister (case 2) presented similarly; liver biopsy showed giant cell hepatitis, which is consistent with idiopathic neonatal hepatitis (INHP). However, iron staining revealed that case 1 had extensive iron deposits in the liver, pancreas, heart, thymus, and bone, but none in bone marrow or spleen. Case 2 had grade 4 liver iron staining, normal bone marrow iron, elevated serum ferritin and transferrin saturation, and HLA-A3 haplotype. At 16 months of age, the growth, development, and serum measures of iron status in case 2 were normal; liver biopsy showed fibrosis, negative iron staining, and normal tissue iron concentration. NHC is compatible with survival, has clinicopathologic features that overlap with INHP, and may frequently be misdiagnosed as INHP. A prospective study is needed to determine the incidence and natural history of NHC a disorder that may be more common than is currently recognized.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We made continuous, simultaneous recordings of esophageal pH from three sites in the esophageal body, for 18–24 h, in 11 children with normal prolonged distal esophageal pH studies (Group I) and in 14 children with abnormal distal esophageal pH recordings (Group II). A flexible catheter housing four antimony microelectrodes was used, and data were stored in a portable recorder. A computer allowed for evaluation of the percent of time esophageal pH was <4.0, number of reflux episodes per hour, acid clearance time, and the duration of longest reflux episode. Recordings made while subjects were upright or recumbent could be distinguished and analyzed separately. In the recumbent position, comparison of pH recordings from distal, middle, and proximal esophageal pH electrodes in Group I showed significant decreases in the percent of time spent with pH <4.0, reflux episodes per hour, acid clearance time, and duration of longest reflux episode in the proximal esophageal sites, with a near negligible total acid exposure in the most proximal electrode. In Group II subjects, however, comparison of recumbent recordings from distal, middle, and proximal esophagus indicates that the proximal esophagus is highly exposed to acid reflux and that the decrease in acid exposure from distal to proximal esophagus in reflux patients is not proportionally as great as that of Group I. The data suggest that in the recumbent position, the ability of the subjects with abnormal reflux scores to protect the upper esophagus is less than that of subjects with normal amounts of distal esophageal acid exposure.

ISSN:0277-2116    

出版商:OVID    

年代:1988

数据来源: OVID