ABSTRACT
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.
Subject(s)
Dilatation , Esophageal Stenosis/therapy , Adolescent , Betamethasone/administration & dosage , Burns, Chemical/complications , Child , Child, Preschool , Esophageal Stenosis/chemically induced , Esophageal Stenosis/etiology , Esophagoscopy , Female , Fluoroscopy , Humans , Infant , MaleABSTRACT
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.
Subject(s)
Diarrhea , Child , Diarrhea/etiology , Diarrhea/therapy , Humans , Risk FactorsABSTRACT
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.
Subject(s)
Diarrhea, Infantile/microbiology , Duodenum/microbiology , Enterobacteriaceae/isolation & purification , Intestine, Small/microbiology , Acute Disease , Age Factors , Antitrichomonal Agents/therapeutic use , Diarrhea, Infantile/drug therapy , Diarrhea, Infantile/etiology , Enterobacteriaceae/drug effects , Enterobacteriaceae/growth & development , Female , Humans , Infant , Infant, Newborn , Male , Metronidazole/therapeutic use , Nutritional Status , Risk FactorsSubject(s)
Giardiasis/complications , Jejunum/pathology , Atrophy , Child , Child, Preschool , Chronic Disease , Diarrhea/etiology , Humans , InfantABSTRACT
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.
Subject(s)
Liver Diseases/genetics , alpha 1-Antitrypsin Deficiency , Adolescent , Child , Child, Preschool , Female , Gene Frequency , Humans , Infant , Isoelectric Focusing , Male , PhenotypeABSTRACT
Two hundred children hospitalized in the National Institute of Gastroenterology were studied during the 1972-1980 period. The children, whose ages ranged between six months and ten years, presented chronic diarrhea in which Giardia lamblia was considered the causative agent. The diagnosis of parasitism was made with the detection of Giardia lamblia in the feces and/or duodenal content. A serum D-Xylose and jejunal biopsy were performed on all the patients and the histology of the mucosa was classified in keeping with the degree of atrophy according to Metayer and Laumonier. In our study we divided the patients into three groups: Group 1, parasitism due to Giardia lamblia in patients with a normal D-xylose and different degrees of atrophy of the jejunal mucosa, but with normal D-Xylose and Group 3, malabsorption due to Giardia lamblia, with a pathological D-Xylose and alterations in the intestinal mucosa. There were 35 cases in Group 1 (17.5%), 91 cases in Group 2 (45.5%) and 74 cases in Group 3 (37%). The predominant intestinal lesion was partial atrophy of the villi (143), 20 with subtotal atrophy of the villi and two with complete atrophy of the villi. It was shown that the host's response to infection by Giardia lamblia varies with differing effects on the structures and functioning of the jejunal mucosa. It is important to group patients with chronic diarrhea due to Giardia lamblia in this way since it allows for and individualized clinical approach and provides a prognosis in terms nutritional consequences resulting from possible persistence of the diarrhea and possible associated lactose intolerance.
Subject(s)
Diarrhea/etiology , Giardiasis/complications , Intestinal Mucosa/pathology , Jejunum/pathology , Child , Child, Preschool , Giardiasis/diagnosis , Humans , Infant , Intestinal Absorption , XyloseABSTRACT
Two hundred children hospitalized in the National Institute of Gastroenterology were studied during the 1972-1980 period. The children, whose ages ranged between six months and ten years, presented chronic diarrhea in which Giardia lamblia was considered the causative agent. The diagnosis of parasitism was made with the detection of Giardia lamblia in the feces and/or duodenal content. A serum D-Xylose and jejunal biopsy were performed on all the patients and the histology of the mucosa was classified in keeping with the degree of atrophy according to Metayer and Laumonier. In our study we divided the patients into three groups: Group 1, parasitism due to Giardia lamblia in patients with a normal D-xylose and different degrees of atrophy of the jejunal mucosa, but with normal D-Xylose and Group 3, malabsorption due to Giardia lamblia, with a pathological D-Xylose and alterations in the intestinal mucosa. There were 35 cases in Group 1 (17.5
), 91 cases in Group 2 (45.5
) and 74 cases in Group 3 (37
). The predominant intestinal lesion was partial atrophy of the villi (143), 20 with subtotal atrophy of the villi and two with complete atrophy of the villi. It was shown that the hosts response to infection by Giardia lamblia varies with differing effects on the structures and functioning of the jejunal mucosa. It is important to group patients with chronic diarrhea due to Giardia lamblia in this way since it allows for and individualized clinical approach and provides a prognosis in terms nutritional consequences resulting from possible persistence of the diarrhea and possible associated lactose intolerance.
ABSTRACT
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.
Subject(s)
Antiprotozoal Agents/therapeutic use , Giardiasis/drug therapy , Intestinal Diseases, Parasitic/drug therapy , Nitroimidazoles/therapeutic use , Tinidazole/therapeutic use , Antiprotozoal Agents/adverse effects , Child , Child, Preschool , Diarrhea, Infantile/drug therapy , Diarrhea, Infantile/etiology , Female , Humans , Infant , Male , Recurrence , Tinidazole/adverse effectsABSTRACT
Se exponen los resultados obtenidos con el tinidazol como unico tratamiento para la giardiasis en la infancia. Se utilizo una dosis de 50 mg/kg de peso/dia, fraccionada en 2 o 3 subdosis durante tres dias por via bucal. Se obtuvo una curacion de un 60% en ninos con giardiasis recidivante.El estudio comprendio 25 ninos entre 7 meses y 8 anos de edad, con un predominio de 13 meses a 3 anos (18 ninos). Los sintomas clinicos antes del tratamiento eran diarreas cronicas (19 ninos) y dolor abdominal (6 ninos). Se reporto la tolerancia al medicamento en 15 casos (60%) y los 10 restantes presentaron intolerancia (vomitos, nauseas, rechazo al sabor y anorexia) con necesidad de descontinuar el tratamiento en 2 casos por vomitos.Entre los 14 ninos curados, el 71% presento una respuesta clinica satisfactoria y el 29% no satisfactoria. Entre los 9 no curados, la tercera parte tuvo una evolucion favorable a pesar de la persistencia del parasitismo Se hace enfasis en el valor del tinidazol (60% de efectividad) y se comparan los resultados con la literatura, pues el criterio de curacion considero la ausencia del parasito en heces fecales y en el contenido duodenal
Subject(s)
Infant , Child, Preschool , Child , Humans , Male , Female , Giardiasis , TinidazoleABSTRACT
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.
Subject(s)
Celiac Disease/diagnosis , Xylose , Adolescent , Celiac Disease/pathology , Child , Child, Preschool , Cuba , Humans , Infant , Intestinal Absorption , Intestinal Mucosa/pathology , Jejunum/pathologyABSTRACT
Se estudian 36 niños, comprendidos entre 9 meses y 13 años, que fueron asistidos en el servicio de pediatría del Instituto de Gastroenterología, con el diagnóstico de enfermedad celíaca, a los que se les realizó biopsia de yeyuno, d-xylosa, van der Kamer y otros. Se señala la incidencia familiar, la asociación con la enteropatía exudativa y la frecuencia con que encontramos pie plano; se insiste en que nuestro medio la regresión histológica, con la supresión del gluten de la dieta, no siempre se observa en los estudios evolutivos, debido al mal manejo dietético en el medio familiar(AU)