Gastroesophageal reflux in children: correlation of symptoms with 24-hour esophageal pH monitoring.

To evaluate the clinical significance of suspected symptoms of GER, 24-hour esophageal pH monitoring was performedin 55 children (mean age of 23.9 months). We used 24-hour esophageal pH monitoring as a gold standard for the diagnosis of pathological GER. The primary indication for the study included frequent vomiting, dysphagia and respiratory diseases (recurrent pneumonia, aspiration pneumonia, hyperreactive airway, apnea and stridor). Forty-seven per cent of these 55 children had pathological GER and 61.5 per cent of them were less than 1-year-old. The sensitivity of frequent vomiting, dysphagia and aspiration pneumonia as symptoms of GER was lowest (7.7%) Recurrent pneumonia had highest sensitivity (50%) but had lowest specificity (31%) among other presenting symptoms. All the other symptoms had high specificity (82.8-100%). Dysphagia, hyperreactive airway and apnea were the presenting symptoms with high positive predictability (100%, 80%, and 75% respectively). We suggest that all children who have a history of dysphagia, hyperreactive airway and apnea should be evaluated for GER.

Cryptosporidium in 100 Australian children.

Over a consecutive 36 month period, 100 patients out of 6,980 (1.4%) from whom stool samples were examined had oocysts of Cryptosporidium detected on fecal microscopy. Three patients were receiving cytotoxic chemotherapy and adequate clinical information was available from 84 of the remainder. Fifty per cent of patients were aged 1 to 2 years, 29% were less than 12 months and the rest were more than 2 years of age. More than one-quarter of the patients were Australian Aborigines. Isolations of cryptosporidia were most prevalent in late summer, autumn and early winter. Most patients (89%) had diarrhea, more than 75% had vomiting and 44% were dehydrated, mostly to a mild degree. Other symptoms included fever (11%) and abdominal pain (11%). Ten percent of patients were apparently symptomless. Cryptosporidium sp. is the second most commonly identified intestinal parasite, after Giardia intestinalis, in fecal specimens examined in our children's hospital. The high rate of isolation in Aboriginal children emphasized the importance of enteric pathogens in this group and the role of inadequate hygiene in relation to diarrheal disease in young Aborigines.

Urinary N-acetyl-beta-D-glucosaminidase (NAG) in aminoglycoside nephrotoxicity.

Urinary N-acetyl-beta-D-glucosaminidase (UNAG) excretion was measured in 37 children before and during the treatment with aminoglycosides at the Department of Pediatrics, Ramathibodi hospital from July 1 to October 31, 1986. There were 20 males and 17 females whose ages ranged from 15 days - 15 years. Twelve were in postoperative status, 11 with respiratory tract disease, 11 with urinary tract disease and 3 in the miscellaneous group. Aminoglycosides were given alone in 11 patients, combined with cloxacillin in 14 and with other antibiotics in 12 patients. The duration of aminoglycoside given ranged from 5-27 days (mean +/- SD = 11.5 +/- 5.5 days). Clinical nephrotoxicity was detected in 12 patients (32.4%), of which 7 were males and 5 were females, 4 were less than 1 year old. It appeared 4-9 days (mean +/- SD = 5.8 +/- 1.6 days) after initiation of the treatment. Variation in age, sex, initial UNAG excretion and antibiotic combination were not associated with increased risk of nephrotoxicity. Thirty patients had elevated baseline UNAG excretion from 1-14 times higher than the normal value. UNAG excretion was increased 0.23-5.57 fold in all patients after 24 hours of treatment. In those with clinical nephrotoxicity, the enzymuria rose more than one fold in all of them (sensitivity 100%, specificity 68%, accuracy 78.4%) and this was detected 2-7 days (mean +/- SD = 3.8 +/- 1.6 days) prior to the rise of serum creatinine.(ABSTRACT TRUNCATED AT 250 WORDS)

Liver size and serum alkaline phosphatase in normal Thai school-aged children.

The purpose of this study is to determine liver size in normal Thai school children aged 6 to 11 years, using both the clinical and ultrasonographic methods. Normal value of serum alkaline phosphatase in this age-group is also obtained. To confirm that liver function is normal, serum alanine transaminase and hepatitis B virus profile were performed. One hundred and fifty-nine normal children from Phyathai School were included in the study. They were divided into 5 age-groups: 6-7, 7-8, 8-9, 9-10 and 10-11 years. Six children were found to be asymptomatic HBsAg carriers (3.8%) and were excluded from the analysis. Mean liver sizes examined separately by two pediatricians were not significantly different, they were 8.47, 9.32, 10.06, 9.64 and 9.38 cm respectively, whereas those obtained by the ultrasonogram were 9.37, 9.17, 9.71, 10.57 and 10.21 cm respectively. Liver was palpable in 15.7 per cent of the children and liver edge did not exceed 2 cm below right costal margin. The mean value of serum alkaline phosphatase, obtained by the automate method, in these children was 223.1 unit/litre and in 97.3 per cent of them, the value did not exceed 350 unit/litre. The results of this study showed that liver size obtained clinically is comparable to size determined by ultrasonogram. Liver size in school children does not increase with age but tends to increase with body weight and height of the children.

Genitourinary tract anomalies in Thai children with urinary tract infection.

One hundred and forty-three pediatric patients with initial documented UTI were analysed retrospectively. E. coli was the most common organism found in uncomplicated cases. Forty-six per cent of 110 patients who had radiologic evaluation had genitourinary tract anomaly with higher frequency in boys during the infancy period and girls during the early childhood period. Primary VUR was found in 11 per cent of patients mainly in infancy with an equal number among boys and girls. We conclude and strongly advise that radiologic evaluation should be done in all children with UTI, especially if they are younger than 5 year old.