Correlation of intestinal mucosal injury with serum diamine oxidase / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between the changes of intestinal mucosal tumor necrosis factor alpha (TNF-alpha), plasma diamine oxidase (DAO) values and the degree of mucosal injuries in young rat model of colitis and thereby to explore if plasma DAO could be used as a potential index for monitoring intestinal mucosal injury.</p><p><b>METHODS</b>One hundred and four healthy young male Sprague-Dawley (SD) rats aged 5-6 weeks were randomly divided into three groups: zero time group (n = 8), model group (n = 48) and control group (n = 48). The model and control groups were further divided into 24 h, 72 h, 1 week, 2 weeks, 3 weeks and 4 weeks subgroups, respectively, with 8 rats in each. The rats in model group were given 2, 4, 6-trinitrobenzene sulfonic acid (TNBSA) via enema to induce colitis, while the rats in the control group were given normal saline (NS) solution in the same way and those in zero time group were not treated. TNF-alpha and DAO were measured by immunohistochemical technique and spectrophotometry.</p><p><b>RESULTS</b>The most serious enteric mucosal injury was seen 24 hours after giving TNBSA. Plasma DAO and TNF-alpha decreased as the intestinal mucosal injury was alleviated.</p><p><b>CONCLUSIONS</b>Plasma DAO values may be used as a marker for intestinal mucosal injury. TNF-alpha is a factor for causing mucosal injury. Young rat colitis model can be used to study intestinal mucosal injury.</p>

Application of metal hemoclip for endoscopic polypectomy in children with thick-pedunculated intestinal polyps / 中华儿科杂志

<p><b>OBJECTIVE</b>With the development of endoscopic therapy in children, endoscopic electrocoagulation polypectomy had gradually replaced surgery and became an important method to resect gastrointestinal polyps in children. Simple electrocoagulation polypectomy could often bring some complications of gastrointestinal bleeding and perforation because of incomplete electrocoagulation or mechanical incision, especially in gastrointestinal thick-pedunculated polyps which always have thick nutrient blood vessel. Hemoclips can successfully interdict arteriovenous blood because it can clamp tissue firmly without causing necrosis around the target area. Based on its good mechanical hemostasis, hemoclips are not only widely used in treating bleeding like from ulcer, tumor and variceal ligation but also used in removal of thick-pedunculated gastrointestinal polyps in adults. This paper describes the application of endoscopic electrocoagulation with metal hemoclips to remove thick-pedunculated intestinal polpys in children for the first time, sums up the experience and evaluates its efficacy and safety.</p><p><b>METHODS</b>Between October, 2001 and December, 2002, 5 cases with thick-pedunculated intestinal polpys were presented. The age of the patients ranged from 3 to 5 years. The clinical features were gastrointestinal bleeding or abdominal pain. The longest course of disease was 2 years. Enough preparations for alimentary tract were necessary for polypectomy. The procedures were performed under general anesthesia in order to avoid the risk of bleeding aspiration. Endoscopy was performed in the standard fashion. The apparatus included electronic colonic endoscope (XQ 200, Fuji Corp, Tokyo, Japan), snare (XQ200, Fuji Corp, Tokyo, Japan), impeller of the clip (HX-5QR-1) and hemoclip (MD850) which could be passed through the biopsy channel of endoscope. The clip was completely covered with a hood avoiding any injury to the mucous membrane. The pedicel with diameter of more than 1.0 cm underwent endoscopic electrocoagulation polypectomy with hemoclips. The clip contacted polyps in upright direction. One or more hemoclips were selected to clamp the proximal basement of the pedicel in terms of the pedicel diameter. Turning of the red colour of polyps to purple suggested that hemoclip interdicted arteriovenous blood effectively. The clip was then shut off and electrocoagulation polypectomy was followed. Six polyps were observed and removed.</p><p><b>RESULTS</b>Six polyps including 2 transverse colon polyps and 4 descending colon polyps were resected. Pathological results showed that 3 were juvenile polyps and the other 3 adenomatous polyps. All the polyps were completely resected. The diameter of pedicel were 1.2 - 2.2 cm. The head and pedicel of the biggest polyp was about 5 cm x 5 cm and 2.2 cm, respectively, and five clips were used in order to remove it. No complications of bleeding and perforation were observed in these children. All hemoclips were expelled from intestines within one week. The symptoms of these patients disappeared.</p><p><b>CONCLUSION</b>Mechanical hemostasis with hemoclips successfully interdicted arteriovenous blood of thick-pedunculated polyps. Hemoclips can successfully prevent the complications of bleeding and perforation. The clipping brings about a new method in endoscopic therapy. Endoscopic electrocoagulation polypectomy with hemoclips is a simple, safe and effective method to treat thick-pedunculated gastrointestinal polyps in children and it is a valuable tool in polypectomy for children.</p>

Long-term outcome after injection sclerotherapy for esophageal variceal bleeding in children with portal hypertension / 中华儿科杂志

<p><b>OBJECTIVE</b>Endoscopic sclerotherapy has emerged as an effective treatment for bleeding esophageal varices in adults and children but the long-term outcome is poorly defined in children. The present study aimed to study the long-term effect of endoscopic sclerotherapy in children with portal hypertension.</p><p><b>METHODS</b>Fifteen patients (age 3 to 14 years) with esophageal variceal bleeding underwent endoscopic injection treatments with 1% Aethoxy-sclerol since 1996. All subjects continued to receive the therapy by repeated intra and extravariceal endoscopic sclerotherapy at intervals of 3 - 4 weeks until the varices disappeared, and received regular endoscopic follow-up.</p><p><b>RESULTS</b>Fifteen patients had totally 43 injections, and were followed up from 40 to 86 months (mean 66 months) by endoscopy. Two patients received 2 injections and 5 received 3 before eradication of varices. The mean time needed for varices eradication was 3 to 6 months. Recurrence of varices and bleeding was seen in 3 patients who had duodenal ulcer.</p><p><b>CONCLUSION</b>Endoscopic sclerotherapy is a safe and effective treatment for pediatric esophageal varices.</p>

Curative Effects of Triple Therapy in Children with Helicobacter Pyl ori Infection / 实用儿科临床杂志

Objective To study the effects of new triple therapy with clarithromycin plus amoxicillin and omeperazole combined into 3 therapeutic therapies, and 3 therapeutic courses to treat children with helicobacter pyloric(Hp) infection.Methods Two hundred and four patients who were diagnosed by gastroscopy as Hp-related gastroentestinal diseases and divided into 3 groups,randomly.Group A was treated with amoxicillin 50 mg/(kg?d)+bismuth citrate 7-8 mg/(kg?d)+metronidzole 15-20 mg/(kg?d) for six weeks;group B took the same drugs but for two weeks;group C was treated with clarithromycin 15 mg/(kg?d)+omeperazole 0.8 mg/(kg?d)+amoxicillin 50 mg/(kg?d) for 2 weeks.Results The rates of eradicate of Hp:group A 73.4%,group B 75%,group C 92%.The differences between group B and group C were very significant.Conclusion Triple therapy is more effective, less duration,well tolerated, less resistant,with higher rate of eradication.