[Enteropathogenic agents isolated in persistent diarrhoea]. / Aislamiento de agentes enteropatogenos en la diarrea persistente.

Out of 45558 patients admited in our hospital, from January 1990 to December 1993, the clinical records of 4445 children with diarrhoea (4289 with acute diarrihoea and 156 with persistent diarrhoea) were reviewed. Those with positive bacteriological or parasitological results were taken as sample. Salmonella was the bacteria most frequently isolated in both groups of patients. ECEP and ECEH had a similar distribution while Shigella showed a higher frequency in cases of persistent diarrhoea, for a third pace of incidence. From the parasitological point of view, Cryptosporidium and Giardia had the same behavior.

[Study of intestinal microflora in children with acute and persistent diarrhea]. / Estudio de la microflora intestinal en niños con diarrea aguda y persistente.

The etiology and pathogenesis of persistent diarrhoea is usually multifactorial and sometimes can not be identified. It is necessary to define if an alteration of the enteric microflora is a risk factor that influence the duration of the diarrhoea. 30 infants with acute diarrhoea and 30 with persistent diarrhoea were studied. A sample of duodenal content was taken by a double-lumen tube and processed microbiologically in search for enteric microorganisms, anaerobic and Candida. These results were correlated with the nutritional status, the previous use of Metronidazole and the results of the stool culture. The presence of bacterial overgrowth and the identification of the duodenal microflora is an important factor for the persistence of the diarrhoea. There was a quantitative and qualitative alteration of the duodenal flora in both groups of patients.

[Treatment of esophageal stenosis with Savary-Gilliard balloons in children]. / Tratamiento con las bujias de Savary-Gilliard en las estenosis esofagicas del niño.

30 patients (less than 15 years old) were admitted for esophageal strictures, 16 of them secondary to corrosive injury. All the patients were treated with endoscopic dilation with Savary Gilliard bougie. The dilatation were done with general anesthesia using an Olympus GIF-XP10 endoscope and with fluoroscopic control. In the esophageal stenosis secondary to caustic ingestion endoscopic injection with Betamethasone was also used. The most frequent site of the stenosis was the upper third of the esophagus, and the main type of stenosis was tubular in the secondary to caustic burns and annular in the other group. In the posteaustic group 385 dilatations were performed in 115 sessions. Two perforations and one sepsis were reported in patients with corrosive stenosis. There was no mortality. 43.7% of the patients with corrosive stenosis and 85.7% with stenosis secondary to other causes obtained complete healing. Oesophageal dilatation with Savary-Gilliary bougies represents a safe and reliable method for the treatment of esophageal strictures.

[Persistent diarrhea]. / Diarrea persistente.

In this article the current concepts on persistent diarrhoea are reviewed. Persistent diarrhoea is important because its aetiology is unclear, is difficult to treat, affects the nutritional status and increases the risk of death. The identification of risk factors for persistent diarrhoea is important because it can obtain valuable information relative to the pathogenesis and prevention of this disease. The concepts of diarrhoea and risk factors are also reviewed. In addition we explore the methods of management and treatment of patients with persistent diarrhoea.

[Intestinal microflora in children with acute and persistent diarrhea]. / Estudio de la microflora intestinal en niños con diarrea aguda y persistente.

The etiology and pathogenesis of persistent diarrhoea is usually multifactorial and sometimes can not be identified. It is necessary to define if an alteration of the enteric microflora is a risk factor that influence the duration of the diarrhoea. 30 infants with acute diarrhoea and 30 with persistent diarrhoea were studied. A sample of duodenal content was taken by a doble-lumen tube and processed microbiologically in search for enteric microorganisms, anaerobic and Candida. These result were correlated with nutritional status, the previous use of Metroonidazol and the results of the stool culture. The presence of bacterial overgrowth and the identification of the duodenal microflora is an important factor for the persistence of the diarrhoea. There was a quantitative and qualitative alteration of the duodenal flora in both groups of patients.

[Morphologic characterization with light and electron microscopy of "nonspecific elements" in biliary drainage]. / Caracterización morfológica al microscopio óptico y electrónico de "elementos inespecíficos" en el drenaje biliar.

Since some years ago in our country are reported "inspecific elements" in biliary drainage, name given to some round shaped structures of approximately 12 microns, which generally appear associated to trophozoites of Giardia lamblia, disappearing after an antigiardia treatment. Many gastroenterologists consider such elements as Giardia, but they are still unknown in nature. Our object was to study them at the optic and electronic microscope for their comparison with the biologic forms of G. lamblia. Samples of rich G. lamblia trophozoites and "inspecific elements" biliary drainage, culture trophozoites and G. lamblia cysts rich feces were used. The samples were processed by a routine technique for transmission electronic microscope, with some modifications. Our studies demonstrated that the morphologic characters of the "inspecific elements" correspond to macrophages.

[The value of the Pi system phenotype in alpha 1-antitrypsin deficiency]. / Valor del fenotipo del sistema Pi en la deficiencia de alfa-i-antitripsina.

One-hundred-and-ten children between the ages of two months and 14 years with the following liver diseases were studied: 16 with acute viral hepatitis, 8 with persistent chronic hepatitis, 31 with active chronic hepatitis, 5 with hepatic steatosis, 11 with cirrhosis of the liver, 24 with newborn cholestasis, 3 with Wilson's disease, 2 with congenital hepatic fibrosis, 5 with metabolic diseases and 5 due to other causes. These children presented Pi system phenotypes in isoelectric focus using ultrafine polyacrylamide gels according to Kuepper's method, with modifications incorporated to determine Alpha-1-antitrypsin (A1-AT) serum level deficiencies in those presenting the Pi ZZ phenotype, a liver biopsy with P.A.S. coloration on digestion of diastase and a family history of the phenotype. Four (3.6%) of the children with Pi ZZ phenotypes showed a decrease of serum A1-AT and the presence of positive P.A.S. inclusions resistant to diastase in the cytoplasm of hepatocytes. Three had a history of postnatal icterus and the fourth presented hepatomegaly. The phenotypic study of the parents showed their being heterozygous (MZ), while siblings were normal (MM). The importance of the diagnosis of A1-AT deficiency and the diagnostic value of detecting Pi system phenotypes in every case of liver disease in children and adolescents is stressed.

Valor del fenotipo del sistema Pi en la deficiencia de alfa-i-antitripsina. / [The value of the Pi system phenotype in alpha 1-antitrypsin deficiency]

One-hundred-and-ten children between the ages of two months and 14 years with the following liver diseases were studied: 16 with acute viral hepatitis, 8 with persistent chronic hepatitis, 31 with active chronic hepatitis, 5 with hepatic steatosis, 11 with cirrhosis of the liver, 24 with newborn cholestasis, 3 with Wilsons disease, 2 with congenital hepatic fibrosis, 5 with metabolic diseases and 5 due to other causes. These children presented Pi system phenotypes in isoelectric focus using ultrafine polyacrylamide gels according to Kueppers method, with modifications incorporated to determine Alpha-1-antitrypsin (A1-AT) serum level deficiencies in those presenting the Pi ZZ phenotype, a liver biopsy with P.A.S. coloration on digestion of diastase and a family history of the phenotype. Four (3.6

) of the children with Pi ZZ phenotypes showed a decrease of serum A1-AT and the presence of positive P.A.S. inclusions resistant to diastase in the cytoplasm of hepatocytes. Three had a history of postnatal icterus and the fourth presented hepatomegaly. The phenotypic study of the parents showed their being heterozygous (MZ), while siblings were normal (MM). The importance of the diagnosis of A1-AT deficiency and the diagnostic value of detecting Pi system phenotypes in every case of liver disease in children and adolescents is stressed.

[Endoscopic polypectomy of the colon in children]. / Polipectomía endoscópica de colon en el niño.

Colon Polyps constitute are one of the most frequent causes of rectal bleeding in infancy. The advent of endoscopic polypectomy through colonoscopy has resulted very useful in their treatment. From 1979 to 1984, 73 polypectomies were performed in 64 patients with colonic polyps, between 2 and 14 years old, 26 girls and 38 boys. 103 polyps were resected, 71 pedunculated and 32 sessiles. The most frequent location was the recto-sigmoid (85.6%), with 14.4% situated above it. 55.7% of the removed polyps were more than 1 cm., juvenile histologic type predominating (90%). No complication was observed either during or after this procedure. It is demonstrated that, endoscopic polypectomy in children is a safe, simple and effective method which avoids complications that may or surgery might produce.

Polipectomía endoscópica de colon en el niño. / [Endoscopic polypectomy of the colon in children]

Colon Polyps constitute are one of the most frequent causes of rectal bleeding in infancy. The advent of endoscopic polypectomy through colonoscopy has resulted very useful in their treatment. From 1979 to 1984, 73 polypectomies were performed in 64 patients with colonic polyps, between 2 and 14 years old, 26 girls and 38 boys. 103 polyps were resected, 71 pedunculated and 32 sessiles. The most frequent location was the recto-sigmoid (85.6

), with 14.4

situated above it. 55.7

of the removed polyps were more than 1 cm., juvenile histologic type predominating (90

). No complication was observed either during or after this procedure. It is demonstrated that, endoscopic polypectomy in children is a safe, simple and effective method which avoids complications that may or surgery might produce.

[Chronic hepatitis in children]. / Hepatitis crónica en el niño.

Results of the diagnosis, evolution and treatment of a study performed during the last 6 years in 50 children, carriers of chronic hepatitis are reported; they were patients of the Pediatric service at the Institute of Gastroenterology, corresponding, 25 to the persistent variety, and the rest to the active. Diagnosis was made by clinical, biochemical, laparoscopic and hepatic histological aspects. The importance of diagnostic laparoscopy and its correlation with hepatic biopsy are indicated. The highest incidence corresponded to patients between 4 and 6 years and 10 and 11 years of age, with a predominance of females. In the persistent variety, normality was achieved with bedrest without the need of medicines. In the active variety, the treatment used was prednisone or its combination with azathioprine, when an adequate response was not obtained or initially in severe cases, obtaining normality in 20% of them with a histological picture of persistent in 16% of the cases and the disease being maintained in 64%, with variations from a degree of inactivity to a now satisfactory picture with a progressive evolution to hepatic cirrhosis. There is no mortality reported in the casuistics.

[Demonstration of celiac disease in Cuba]. / Demonstración de la enfermedad celíaca en Cuba.

A study performed in 50 children carriers of celiac disease with ages between 8 months and 14 years of age, is presented; diagnosis was proved based on clinical picture, histological changes of jejunal mucosa, intestinal absorption tests and response to the suppression of gluten from the diet, with clinical, histological and biochemical control according to international criteria. It has been insisted on the familial study and the gluten overload test and its incidency in the black race. The development of public health has made it possible to demostrate the existence of this disease in our country.