ABSTRACT
BACKGROUND: Literature information regarding clinical and histological correlates in celiac disease is limited. The present study was designed to assess the value of various clinical parameters in predicting the severity of small bowel histopathology. METHODS: Small bowel biopsy specimens of 59 children with established celiac disease (ESPGAN criteria) were evaluated blindly. Morphology was evaluated based on a common histopathology score. The following clinical variables were evaluated: age at diagnosis, duration of symptoms, severity score of clinical symptoms, severity score of physical signs, and growth parameters (height and weight Z scores). Multiple regression analysis was performed to evaluate the relative importance of each clinical parameter. RESULTS: Only three clinical variables revealed a significant correlation with the histopathology score. The symptom severity score (t = 3.883, p = 0.0003) demonstrated a positive correlation. The two others, age at diagnosis (t = 3.076, p = 0.0032) and duration of symptoms (t = -2.987, p = 0.0041), revealed a negative correlation. CONCLUSIONS: We conclude that more severe clinical symptoms of a shorter duration, presented at a younger age, are better predictors of a more severe form of small bowel histopathology in children with celiac disease.
Subject(s)
Celiac Disease/pathology , Intestine, Small/pathology , Adolescent , Biopsy , Celiac Disease/physiopathology , Child , Child, Preschool , Female , Humans , Infant , Male , Medical Records , Regression Analysis , Retrospective Studies , Severity of Illness IndexABSTRACT
Recent immigration from eastern Europe to Israel (1990-1992) has brought to the Negev many uncircumcised newcomers. The rationale for circumcising healthy children has been a matter of controversy, not yet settled. Healthy adults are not usually circumcised except for ritual reasons. In the past 3 years we circumcised 2857 males 1-64 years old, mostly of Russian origin. All were operated on as outpatients on a 1-day, ambulatory service. 75% of the newcomers were operated on during the first 6 months after immigration. 86% of the circumcisions were done under general anesthesia and the rest under local. After stretching the prepuce backwards, the foreskin was excised. Hemostasis was achieved with the aid of electrocautery and the skin was approximated with in absorbable sutures. All patients were re examined 1 week later. There were complications in 50 (1.75%), consisting mostly of postoperative bleeding and wound infections. We conclude that ritual circumcision is a safe procedure in normal adults.