ABSTRACT
Pacientes y métodos: Seis niños de 4-8 años de edad, 4 varones, con hematemesis y/o melenas, fueron diagnosticados de gastritis hemorrágica aguda en un periodo de 6 semanas durante los meses de octubre y noviembre de 2007. Se realizaron las siguientes pruebas: hemograma, pruebas de coagulación, frotis faríngeo y rectal para virus, bacterias y hongos, serologías virales y serología y test de urea-C13 espirado para Helicobacter pylori. Resultados: Un niño presentaba un cuadro febril, 5 niños dolor abdominal, 6 hematemesis, 3 melenas y 3 heces negras. Ninguno de los niños sufría gastroenteritis aguda. Las pruebas de coagulación fueron normales en los 6 niños. Cuatro de los niños tenían un nivel de hemoglobina <8,5 g/dL. La endoscopia digestiva alta mostró signos de sangrado o de gastritis aguda en todos ellos. Se aisló el enterovirus Coxsackie A en los cultivos faríngeo y rectal del caso índice, y se detectó una serología de enterovirus IgM positiva en otros 3 casos. No se aisló ni identificó H. pylori u otros patógenos en ningún niño. Conclusiones: En 4 de los 6 niños con un brote epidémico de gastritis hemorrágica se pudo comprobar la asociación de infección aguda por enterovirus. La gastritis hemorrágica era una manifestación no descrita hasta ahora en las infecciones por enterovirus (AU)
Introduction: The acute hemorrhagic gastritis is a rare pathologyin pediatric age. There are no references in the medical literature of outbreaks of hemorrhagic gastritis. Patients and methods: Six children between 4 and 8 years of age, 4 males, with hematemesis and/or melenas were diagnosed with acute hemorrhagic gastritis in a period of 6 weeks during the months of October and November 2007. Different exams were carried out: full blood count, clotting tests, rectal and pharyngeal swabs for viruses, bacteria and fungi, viral serologys and C-13 urea breath test for Helicobacter pylori. Results: One child had fever, 5 children abdominal pain, 6children hematemesis, 3 melenas and 3 black feces. None of the children had signs or symptoms of acute gastroenteritis. The coagulation test was normal in the children. Four of the children had hemoglobin below 8.5 g/dL. The upper digestive endoscopy (UDE) showed signals of bleeding or of acute gastritis in all of them. The enterovirus Coxsackie virus A was isolated in the pharynx and rectal culture of the first patient and in 3 other cases. IgM positive serology for enterovirus was found in one patient. Helicobacter pylori or other pathogens were not found in any child. Conclusions: In 4 of the 6 children an outbreak of hemorrhagic gastritis was verified with the relationship to the acute infection by enterovirus. The hemorrhagic gastritis was a manifestation, which had not been described until now in enterovirus infections (AU)
Subject(s)
Humans , Male , Female , Child , Gastritis/complications , Gastritis/diagnosis , Gastritis/pathology , Enterovirus Infections/complications , Enterovirus Infections/diagnosis , Enterovirus Infections/pathology , Hematemesis/complications , Hematemesis/diagnosis , Hematemesis/pathology , Melena/complications , Melena/diagnosis , Melena/pathology , Helicobacter pylori/pathogenicityABSTRACT
This document summarizes the issues raised in a think tank meeting held by professionals with expertise in pediatric Home Parenteral Nutrition. This nutritional technology enables patients to return home to their family and social environment, improves their quality of life and decreases health-care costs; however, it is complex and requires an experienced nutritional support team. Patient selection is normally made according to their underlying disease, the estimated duration of support and family and social characteristics. The patients family must agree to take on caregivers responsibilities and should be able to perform treatment safely and effectively after receiving proper training from the nutritional support team. Close monitoring must be carried out to ensure tolerance and effectiveness of nutritional support, there by avoiding complications. This nutritional treatment achieves, in most cases, recovery and intestinal adaptation in varying periods of time. In certain diseases, and when home parenteral nutrition becomes complicated, intestinal transplant may be recommendable, so referral to rehabilitation units and Intestinal Transplantation should be made early on (AU)
El presente documento resume los aspectos abordados en una Jornada de puesta en común con la participación de profesionales con experiencia en nutrición parenteral domiciliaria pediátrica. Este tratamiento permite el retorno de los pacientes a su medio familiar y social, mejora su calidad de vida y disminuye los costes sanitarios pero es complejo y requiere un equipo de soporte nutricional experimentado. La selección del paciente se realizará en función de su enfermedad de base, la duración estimada del soporte y las características familiares y sociales. La familia del paciente ha de querer hacerse cargo de su cuidado y debe ser capaz de realizar el tratamiento de forma segura y eficaz tras recibir la formación adecuada por el equipo de soporte nutricional. El seguimiento ha de efectuarse de forma estrecha para asegurar la tolerancia y eficacia del soporte, evitando las complicaciones. Este tratamiento nutricional consigue, en la mayoría de los casos, la recuperación y adaptación intestinal en periodos variables de tiempo. En ciertas patologías y cuando la nutrición parenteral domiciliaria se complica puede estar indicado el trasplante intestinal, por lo que la remisión a las Unidades de Rehabilitación Intestinal y Trasplante debe hacerse de forma precoz (AU)
Subject(s)
Humans , Male , Female , Child , Parenteral Nutrition, Home/methods , Nutritional Support/methods , Child Nutrition Disorders/therapy , Home Care Services, Hospital-Based/organization & administration , Quality of Life , Caregivers/education , Patient SelectionSubject(s)
Abdominal Pain/etiology , Superior Mesenteric Artery Syndrome/complications , Adolescent , Humans , Male , RecurrenceABSTRACT
This document summarizes the issues raised in a think-tank meeting held by professionals with expertise in pediatric Home Parenteral Nutrition. This nutritional technology enables patients to return home to their family and social environment, improves their quality of life and decreases health-care costs; however, it is complex and requires an experienced nutritional support team. Patient selection is normally made according to their underlying disease, the estimated duration of support and family and social characteristics. The patient''s family must agree to take on caregiver's responsibilities and should be able to perform treatment safely and effectively after receiving proper training from the nutritional support team. Close monitoring must be carried out to ensure tolerance and effectiveness of nutritional support, thereby avoiding complications. This nutritional treatment achieves, in most cases, recovery and intestinal adaptation in varying periods of time. In certain diseases, and when home parenteral nutrition becomes complicated, intestinal transplant may be recommendable, so referral to rehabilitation units and Intestinal Transplantation should be made early on.
