Diagnostic evaluation of infantile cholestasis.

OBJECTIVE: To evaluate diagnostic accuracy of some important clinical manifestations and different investigations in infantile cholestasis. MATERIAL AND METHOD: Infants diagnosed with prolong conjugated hyperbilirubinemia and admitted to Chiang Mai University Hospital between Jan 1999 and Feb 2003. Demographic and clinical data were recorded Routine biochemical tests, and serology for TORCHS infections were carried out. An abdominal ultrasonography, DISIDA scan and percutaneous/open liver biopsy were performed. Hyperechoic band at the level of portal bifurcation, named triangular cord (TC) sign was blindly assessed on ultrasonography by the same radiologist. The patients were diagnosed as BA if either operative findings of atretic common bile duct/ gallbladder or evidence of bile duct obstruction demonstrated by intraoperative cholangiography was noted RESULTS: Sixty-one patients were diagnosed as BA (n = 31) and NH (n = 30) with an average age at diagnosis of 88.6 and 63.1 days respectively. Concerning clinical presentations, only the presence of acholic stool was significantly different between BA and NH (p = 0.006). The GGT level of greater than 500 IU/L was significantly found in BA (p < 0.001). The acholic stool and GGT level more than 500 IU/L were highly specific for BA at 100 and 96.6% respectively. In addition, the sensitivity and specificity of US-TC and DISIDA scan were 87.4, 100 and 89. 7, 92.0% respectively. The accuracy for diagnosis of BA were highest by DISIDA scan (96.3) followed by US-TC (86.9), GGT level of > 500 IU/L(81.0) and acholic stool (80.3) in order CONCLUSION: There was no single laboratory investigation that could precisely make a definite diagnosis of BA. The acholic stool and GGT level of higher than 500 IU/L were highly specific for BA. The TC in ultrasound is noninvasive and easily available tests when combined with acholic stool and the GGT level is suggested plan of management.

Incidence of antibiotic-associated diarrhea in a pediatric ambulatory care setting.

BACKGROUND: Although antibiotic-associated diarrhea (AAD) is a common adverse event in children receiving oral antibiotics, few epidemiological studies have investigated this issue. OBJECTIVE: To determine the incidence of AAD in children who received oral antibiotics at the Pediatric Outpatient Department, Chiang Mai University Hospital. MATERIAL AND METHOD: Children who were prescribed oral antibiotics between September 2004 and June 2005 were randomly enrolled. Subjects with immunodeficiencies, acute/chronic diarrhea, and a history of having taken antibiotics within two weeks prior to this visit were excluded Patients' characteristics including age, gender principal diagnosis, and type of antibiotics were recorded. Parents were asked to observe stool frequency and consistency until one week after discontinuing antimicrobial agents and fill out an appropriate questionnaire. AAD was defined if there were at least three loose or liquid stools per day for two consecutive days. Risk factors including age, type, and dosage of the antibiotics used, were analyzed RESULTS: Two hundred and twenty-five children were eligible for data analysis. The mean age was 4.1 years (0.3-14.5 years). Pharyngotonsillitis was the most common diagnosis (53.8%), and amoxicillin and cloxacillin comprised the most common antibiotics prescribed in the present cohort. The incidence ofAAD was 6.2%. All episodes were presented while the patients were taking antibiotics with a mean (+/- SD) onset and duration of occurrence of 2.28 +/- 1.13 and 2.64 +/- 1.15 days, respectively. Premature discontinuation of antimicrobial agents was reported in nine patients (64.3%). There was a trend towards a higher incidence of AAD in the amoxicillin/clavulanate group (16.7%) compared to amoxicillin (6.9%) and erythromycin (11.1%) groups, although it was not statistically significant. In addition, the present study could not demonstrate an association between younger age or the high dosage of antibiotics used, and the development ofAAD. CONCLUSION: AAD was not uncommon in a pediatric ambulatory care setting. It tended to occur in younger children receiving amoxicillin/clavulanate.

Effect of systematic psychological preparation using visual illustration prior to gastrointestinal endoscopy on the anxiety of both pediatric patients and parents.

BACKGROUND: Anxiety, a psychological response to stress, can affect a child undergoing medical procedures, and their family members. The purpose of the present study was to evaluate the benefit of detailed systematic information using a set of real photograph-based technical illustrations provided to both parents and patients before performing endoscopy on the level of anxiety. MATERIAL AND METHOD: All children eligible for gastrointestinal endoscopy were consecutively enrolled from December 2003 to May 2004. Before and after providing systematic psychological preparation, the parents and patients older than five years of age were asked to score their anxiety on the procedures using visual analogue scale (VAS). RESULTS: There were fifty-four patients enrolled during the study period Of these, twenty-five children were older than five years of age. The most common indication of gastrointestinal endoscopy was lower gastrointestinal bleeding. The esophagogastroduodenoscopy, colonoscopy, and both upper and lower endoscopies were performed in 50%, 37%, and 13% of the cases, respectively. The mean and standard deviation of VAS on anxiety of the parents (n = 54) before and after providing systematic information were 3.89 +/- 3.45 and 1.90 +/- 2.46, respectively (p < 0.001). These values on anxiety of the children older than 5 years of age before and after providing systematic information were 4.38 +/- 3.72 and 3.36 +/- 3.69, respectively (p = 0.143). There was no statistically significant impact of types ofp rocedure, level of education, family s income, age of children, and birth order on the level of anxiety. CONCLUSION: The preparatory intervention using systematic visual illustration of the technical procedures in children undergoing gastrointestinal endoscopy could significantly reduce the parents' anxiety.

The endoscopic diagnosis of intestinal capillariasis in a child: a case report.

A 13-year-old boy was diagnosed as having intestinal capillariasis by gastroduodenoscopy. He presented with a 10-month history of chronic abdominal pain and diarrhea. The boy had stayed in central Thailand and had eaten uncooked fish and raw shellfish. Gastroduodenoscopy showed normal jejunal mucosa although histology revealed flattened villi, crypt proliferation, acute inflammation, and eosinophilic granulomata. An egg of Capillaria philippinensis was also seen. The child was treated with mebendazole for 30 days. He had gained six kilograms by the time of his last follow-up.

Severe upper gastrointestinal hemorrhage in the newborn.

Three infants with severe upper gastrointestinal hemorrhage with esophagogastroduodenoscopic (EGD) findings were reported. The underlying conditions of these infants included Down's syndrome, hypoplastic left heart, and diaphragmatic hernia. The precipitating factors were identified in all cases, including prenatal stress, hypoxemia, prolonged ventilatory support, and gastroesophageal reflux. The EGD findings were composed of multiple gastric ulcers and a duodenal ulcer in the first 2 cases, whereas esophagitis and gastritis were noted in the last case. These ulcers were classified as secondary peptic ulcers. All cases responded well to medical treatment, including ranitidine, sucralfate, omeprazole, cisapride, and octreotide.