ABSTRACT
Until recently, biliary lithiasis was considered infrequent in childhood. According to their composition, gallstones can be classified into cholesterol stones and pigment stones. The latter are mainly composed of calcium salts of unconjugated bilirubin and are divided into hard black and soft brown stones. In children, up to 75 % of gallstones are pigment stones. Their etiology is often unknown. Biliary lithiasis in children differs from that in adults and there is very little scientific evidence on the most suitable therapeutic procedures. Symptom-free stones usually have a benign course and do not require medical or surgical treatment. Symptoms are often nonspecific and include dyspepsia and chronic abdominal pain. These symptoms are an indication for ultrasonographic scan to rule out the presence of gallstones. Cholecystectomy is the definitive treatment for gallstones but is not always indicated. Medical treatment with ursodeoxycholic acid is indicated in oligosymptomatic and asymptomatic lithiasis with transparent, soft, cholesterol-rich stones and a functional bladder and in patients with a high surgical risk.
Subject(s)
Gallstones , Child , Gallstones/chemistry , Gallstones/surgery , HumansABSTRACT
Hasta hace pocos años, la litiasis biliar en la infancia se consideraba una enfermedad infrecuente. Según su composición, los cálculos biliares se clasifican en cálculos de colesterol y cálculos de pigmento. Los cálculos de pigmento están formados mayoritariamente por sales cálcicas de bilirrubina no conjugada y se subdividen en negros duros y marrones blandos. En los niños, el 75 por ciento de los cálculos son de pigmento. Con frecuencia, los cálculos en los niños no tienen una causa conocida. La litiasis biliar en el niño presenta peculiaridades diferentes de la del adulto y existe poca literatura médica sobre los procedimientos terapéuticos más idóneos. Los cálculos asintomáticos tienen una evolución benigna y no precisan tratamiento médico ni quirúrgico. Las manifestaciones clínicas de la litiasis suelen ser poco específicas, incluyen molestias como dispepsias o dolores abdominales crónicos por los que los niños son estudiados ecográficamente, encontrándose los cálculos en la vesícula biliar. El tratamiento definitivo de la litiasis es la colecistectomía, pero esto no significa que siempre haya que optar por un tratamiento quirúrgico definitivo. El tratamiento médico con ácido ursodesoxicólico (AUDC) está indicado en las litiasis asintomáticas y oligosintomáticas con cálculos transparentes, blandos, ricos en colesterol y vesícula funcionante y en los casos con alto riesgo quirúrgico (AU)
Subject(s)
Child , Humans , GallstonesABSTRACT
La fibrosis quística es una enfermedad autosómica causada por mutaciones el gen que modula la proteína CFTR responsable del canal de cloro. La enfermedad se caracteriza por infecciones crónicas del aparato respiratorio, insuficiencia pancreática y concentraciones elevadas de electrolitos en sudor. Aunque se trata de una enfermedad multisistémica, la alteración pulmonar es la causa mayor de morbilidad y mortalidad. La insuficiencia pancreática exocrina está presente en la mayoría de los pacientes. Hasta hace poco tiempo, el diagnóstico se basaba en criterio clínicos y esencialmente en la elevación del cloro en sudor. Ahora se conocen más de novecientas mutaciones responsables de la enfermedad y la demostración de alguna de estas o la demostración in vivo de la alteración del transporte iónico en el epitelio nasal, son también criterios diagnósticos. El tratamiento se basa en la prevención controlando cuidadosamente los aspectos nutritivos, gastrointestinales y pulmonares para permitir un crecimiento y desarrollo normal del niño que permita llegar a la edad adulta en buenas condiciones (AU)
Subject(s)
Adolescent , Adult , Female , Child, Preschool , Infant , Male , Child , Infant, Newborn , Humans , Cystic Fibrosis/complications , Cystic Fibrosis/diagnosis , Cystic Fibrosis/etiology , Cystic Fibrosis/therapy , Mutation/physiology , Mutation/genetics , Pancreatitis/complications , Pancreatitis/diagnosis , Pancreatitis/therapy , Diabetes Mellitus/complications , Diabetes Mellitus/diagnosis , Diabetes Mellitus/therapy , Respiratory Tract Infections/complications , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/microbiology , Enzymes/therapeutic use , Bronchodilator Agents/therapeutic use , Sputum/microbiology , Sputum/enzymology , Cystic Fibrosis Transmembrane Conductance Regulator/physiology , Cystic Fibrosis Transmembrane Conductance Regulator/genetics , Cystic Fibrosis Transmembrane Conductance Regulator/analysis , Cystic Fibrosis Transmembrane Conductance Regulator/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Food and Nutritional Surveillance/methods , Food, Fortified , Child Nutritional Physiological Phenomena/education , Infant Nutritional Physiological Phenomena/education , Lung Diseases/complications , Lung Diseases/diagnosis , Lung Diseases/mortality , Lung Diseases/therapy , Exocrine Pancreatic Insufficiency/complications , Exocrine Pancreatic Insufficiency/diagnosis , Exocrine Pancreatic Insufficiency/mortality , Exocrine Pancreatic Insufficiency/therapy , Exocrine Pancreatic Insufficiency/enzymology , Anti-Bacterial Agents/therapeutic use , Pseudomonas aeruginosa/isolation & purification , Staphylococcus aureus/isolation & purification , Sweat/microbiology , Sweat , Sweating , Consensus Development Conferences as TopicSubject(s)
Cystic Fibrosis/therapy , Administration, Inhalation , Administration, Oral , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/therapeutic use , Cystic Fibrosis/drug therapy , Humans , Infusions, Intravenous , Research , Respiratory TherapyABSTRACT
OBJECTIVE: The aim of this study was to investigate the usefulness of five diagnostic tests for Helicobacter pylori (Hp) infection in children. PATIENTS AND METHODS: Sixty-five children with epigastric pain, recurrent abdominal pain, regurgitation, diarrhoea, anemia and insulin-dependent diabetes mellitus were investigated. Endoscopic biopsies from gastric antrum were performed and examined by the urease rapid test, histological examination and microbiological culture. An ELISA was used to detect specific IgG and anti-Hp. A carbon urea breath test was performed in 58 patients. RESULTS: Fifty-three patients were infected with Hp. The endoscopy appearance revealed nodularity in antral mucosa in 42 (79%) and erosions in 1 patient. The histology showed gastritis in all patients infected and Hp was identified in 46. The urease rapid test was positive in 96% and the culture positive in 89% of the patients infected. IgG antibodies to Hp were detected in 67% of the patients infected and the carbon urea breath test was positive in 96%. Twelve children were Hp negative, two of them having gastritis without Hp by histology. In the urease rapid test 3 false-positive results were detected and 1 false positive was found in the cultures. All Hp negative patients had negative results in the carbon urea breath test and were negative for IgG antibodies to Hp. CONCLUSIONS: The carbon urea breath test has a high sensitivity and specificity for the diagnosis of Hp infection and allows the selection of candidates for endoscopy.
Subject(s)
Helicobacter Infections/diagnosis , Helicobacter pylori , Adolescent , Antibodies, Bacterial/blood , Biopsy , Breath Tests/methods , Child , Child, Preschool , Female , Gastric Mucosa/microbiology , Gastric Mucosa/pathology , Gastroscopy , Helicobacter pylori/enzymology , Helicobacter pylori/immunology , Helicobacter pylori/isolation & purification , Humans , Male , Sensitivity and Specificity , Urease/analysisABSTRACT
We studied ten patients with Cystic fibrosis. The purposes of this study were to investigate the presence of gastroesophageal reflux and establish the probable association between gastroesophageal reflux and pulmonary and gastric involvement. All 10 patients underwent 24-hour esophageal pH recording, spirometry and gastric function. Abnormal reflux index was found in all these patients. Lung function was pathologic in the 3 older children. There were no relationship between the severity of the gastroesophageal reflux and the degree of pulmonary damage. No patient has gastric acid hypersecretion. Eight of 10 patients had steatorrhea. Our findings confirm the high frequence of gastroesophageal reflux in cystic fibrosis.
Subject(s)
Cystic Fibrosis/complications , Gastroesophageal Reflux/etiology , Lung/physiopathology , Stomach/physiopathology , Adolescent , Child , Cystic Fibrosis/physiopathology , Female , Gastric Acidity Determination , Gastroesophageal Reflux/physiopathology , Humans , Male , Respiratory Function TestsABSTRACT
Intestinal permeability was studied in a group of 10 children diagnosed of coeliac disease either when they presented an intestinal villi atrophy while receiving a gluten-containing diet and after, when they had a normal mucosa with the withdrawal of gluten from the diet. Ten healthy children served as controls. The 51 Cr-EDTA (51 Cr-ethylenediaminetetraacetate) was used as probe molecule and it was administered orally. Its urinary excretion showed clear differences between patients with an altered intestinal biopsy and those with a normal histopathology. The excretion of 51 Cr-EDTA remained elevated in celiac patients with a gluten-free diet and normal villi.
Subject(s)
Celiac Disease/physiopathology , Edetic Acid/pharmacokinetics , Glutens/administration & dosage , Intestinal Absorption , Administration, Oral , Biopsy , Case-Control Studies , Celiac Disease/metabolism , Child , Child, Preschool , Diet , Edetic Acid/administration & dosage , Edetic Acid/analysis , Female , Humans , Intestinal Mucosa/pathology , MaleABSTRACT
Presentamos un estudio sobre la permeabilidad intestinal en una serie de diez niños diagnosticados de enfermedad celiaca cuando tomaban una dieta con gluten y tenían una atrofia severa de las vellosidades intestinales y posteriormente durante un período con dieta sin gluten y vellosidades intestinales normales. Tomamaos como grupo control a diez niños sanos. Se utilizó como marcador el EDTA-Cr51 (Etiléndiaminotetracetato Cr51) administrado por vía oral. Su excreción urinaria estaba signficativamente elevada en los pacientes con biopsia alterada, manteniéndose una moderada elevación en los pacientes celiacos con dieta exenta de gluten y sin atrofia de las vellosidades
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Intestinal Absorption , Edetic Acid/administration & dosage , Celiac Disease/complications , Glutens/administration & dosage , Edetic Acid/analysis , Administration, Oral , Biopsy , Case-Control Studies , Diet , Intestinal Mucosa/pathologyABSTRACT
Intestinal permeability was studied in a group of 10 children diagnosed of coeliac disease either when they presented an intestinal villi atrophy while receiving a gluten-containing diet and after, when they had a normal mucosa with the withdrawal of gluten from the diet. Ten healthy children served as controls. The 51 Cr-EDTA (51 Cr-ethylenediaminetetraacetate) was used as probe molecule and it was administered orally. Its urinary excretion showed clear differences between patients with an altered intestinal biopsy and those with a normal histopathology. The excretion of 51 Cr-EDTA remained elevated in celiac patients with a gluten-free diet and normal villi.
ABSTRACT
Presentamos un estudio sobre la permeabilidad intestinal en una serie de diez niños diagnosticados de enfermedad celiaca cuando tomaban una dieta con gluten y tenían una atrofia severa de las vellosidades intestinales y posteriormente durante un período con dieta sin gluten y vellosidades intestinales normales. Tomamaos como grupo control a diez niños sanos. Se utilizó como marcador el EDTA-Cr51 (Etiléndiaminotetracetato Cr51) administrado por vía oral. Su excreción urinaria estaba signficativamente elevada en los pacientes con biopsia alterada, manteniéndose una moderada elevación en los pacientes celiacos con dieta exenta de gluten y sin atrofia de las vellosidades (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Intestinal Absorption/drug effects , Edetic Acid/administration & dosage , Celiac Disease/complications , Glutens/administration & dosage , Edetic Acid/analysis , Intestinal Mucosa/pathology , Biopsy , Diet , Administration, Oral , Case-Control StudiesSubject(s)
Inflammatory Bowel Diseases , Adolescent , Child , Child, Preschool , Colon/surgery , Combined Modality Therapy , Enteral Nutrition , Humans , Infant , Inflammatory Bowel Diseases/diagnosis , Inflammatory Bowel Diseases/etiology , Inflammatory Bowel Diseases/therapy , Parenteral NutritionABSTRACT
Between 1980 and 1990, we have diagnosed fourteen cases of cholelithiasis in children at our hospital. Abdominal pain was the most common symptom. Diagnosis was made by abdominal ultrasonography in all of the cases. Risk factors were found in 4 children. Family history was present in four patients. The treatments performed included cholecystectomy in five cases, extracorporeal lithotripsy in one case and a dietary regimen with regular clinical reviews in eight patients.
Subject(s)
Cholelithiasis/diagnostic imaging , Adolescent , Age Factors , Child , Cholecystectomy , Cholelithiasis/surgery , Female , Humans , Infant , Lithotripsy , Male , Risk Factors , UltrasonographyABSTRACT
Treatment of caustic ingestion in children is a difficult and controversial problem which has not yet to be resolved. Here we report the evolution of fourteen children with esophageal injury after caustic ingestion that were treated with steroids at high-doses, nasogastric intubation and antibiotics. An early esophagoscopy was performed in all patients. Four patients developed esophageal strictures, three of which were mild and subsequent dilatation was successful. Only one patient was referred to surgery. We think that although it cannot be established, the use of high-dose of steroids and nasogastric intubation may be helpful for children with caustic esophagitis. We conclude that early endoscopy is useful to evaluate the severity of the lesions and to establish the necessity for treatment.
Subject(s)
Burns, Chemical/etiology , Caustics/adverse effects , Esophagitis/chemically induced , Anti-Bacterial Agents/therapeutic use , Burns, Chemical/diagnosis , Burns, Chemical/therapy , Child, Preschool , Dilatation , Esophagitis/diagnosis , Esophagitis/therapy , Esophagoscopy , Fiber Optic Technology , Humans , Infant , Steroids/therapeutic useABSTRACT
Autoimmune hemolytic anemia and severe giant cell hepatitis is an very uncommon association. Two patients aged 5 months and 2 years developed severe anemia, jaundice, hepatomegaly and splenomegaly. Laboratory tests demonstrated autoimmune hemolytic anemia and elevated amino-transferases. Diffuse giant cell transformation and distorted architecture was seen in liver biopsy. One patient had a cytomegalovirus infection. Early steroid therapy did not prevent fatal course with liver failure in one patient.
Subject(s)
Anemia, Hemolytic, Autoimmune/complications , Hepatitis/complications , Anemia, Hemolytic, Autoimmune/immunology , Hepatitis/immunology , Humans , Infant , MaleABSTRACT
Over one half of the cases of chronic severe childhood asthma, refractory to conventional therapy and without other over aetiology, are associated to gastroesophageal reflux (GER). The aetiopathogenic role of GER in asthma is uncertain, and is only confirmed when therapy of the former induces evident improvement of the latter. We have instituted medical antireflux therapy over two years in 17 patients (17.6%) became asymptomatic after less than three months of therapy, and a further four (23.5%) by the sixth month. Seven patients showed clinical improvement by the third month (41%) and even a greater one by the sixth month, only very slight symptoms persisting thereafter. In three cases (17.6%) there was no improvement after two years of outcome of asthma and the persistence or not of pathological between the outcome of asthma and the persistence or not of pathological 24-hour pHmetry. On the contrary. macroscopic oesophagitis disappeared in the cases of asthma with good outcome, but persisted in all the cases who remained symptomatic. In conclusion, we consider that medical management of GER associated to asthma should be maintained for at least six months (if the clinical course so permits) before considering a surgical indication.
Subject(s)
Asthma/complications , Gastroesophageal Reflux/complications , Adrenal Cortex Hormones/therapeutic use , Adrenergic beta-Antagonists/therapeutic use , Asthma/drug therapy , Child , Child, Preschool , Cimetidine/therapeutic use , Esophagitis/complications , Esophagitis/drug therapy , Gastroesophageal Reflux/drug therapy , Histamine H2 Antagonists/therapeutic use , Humans , Infant , Theophylline/therapeutic useABSTRACT
We present 28 children, 4 to 14 year-old, with duodenal ulcer; there were 21 males and 7 females. In 16 cases, after stimulation with pentagastrin, basal pepsinogen I (PG1), basal gastrinemia and basal acid output (BAO) and maximal acid output (MAO) were measured. Compared to controls, the mean levels of PG1 and gastrin were significantly higher in the patients; 12 children (80%) had high levels of PG1 and the remaining 3 (20%) had normal levels. The blood group O was the most prevalent: 64% of the cases.
Subject(s)
Duodenal Ulcer/physiopathology , Gastric Acid/metabolism , Gastrins/blood , Pepsinogens/blood , ABO Blood-Group System , Adolescent , Child , Child, Preschool , Disease Susceptibility , Duodenal Ulcer/blood , Female , Gastroscopy , Humans , Male , PentagastrinABSTRACT
In order to determine the prevalence of hepatitis B virus (HBV) markers, we studied 375 healthy children, 242 males and 113 females, with age ranged between 6 to 14 years, from different schools at the Tetuán district (Madrid). We sent a questionnaire to the parents to investigate the presence of risk factor in the children and/or their parents. All children were screened for hepatitis B markers in serum. Our results shown the existence of HBV markers in 22 (5.9%) children. No major incidence of risk factors was found in the children with serologic evidence of HBV infection.
