Circumcision as treatment for Zoon's balanitis in an HIV-positive teenage patient.

In this report we describe a case of the Zoon's balanitis in a boy with HIV (AIDS B2). The clinical presentation, failure of topical treatment, cure by circumcision, and the histopathology findings are presented.

Gastric yield pressure and gastric yield volume to assess anti-reflux barrier in a porcine model.

Anti-reflux barrier (ARB) resistance may be useful to test new treatments for gastroesophageal reflux (GER). The ARB has been estimated by increasing gastric yield pressure (GYP) and gastric yield volume (GYV) in animal models but has not been validated. This study aimed to develop an experimental model suitable for assessing the ARB resistance to increasing intragastric pressure and volume and its reproducibility in a seven-day interval. Ten two-month-old female Large-White swine were studied. Intragastric pressure and volume were recorded using a digital system connected to a Foley catheter inserted through gastrostomy into the stomach. GYP and GYV were defined as the gastric pressure and volume able to yield gastric contents into the esophagus detected by esophageal pH. A sudden pH drop below 3 sustained during 5 min was considered diagnostic for gastric yield. Animals were studied again after seven days. On days 0 and 7, there were no significant differences for GYP (mean ± SD = 7.66 ± 3.02 mmHg vs. 7.07 ± 3.54 mmHg, p = .686) and GYV (636.70 ± 216.74 ml vs. 608.30 ± 276.66 ml; p = .299), respectively. Concordance correlation coefficient (ρc) was significant for GYP (ρc = 0.634, 95% CI = 0.141-0.829, p = .006), but not for GYV (ρc = 0.291, 95% CI = -0.118 to 0.774, p = .196). This study demonstrated an experimental model, assessing the ARB resistance. GYP seems to be a more reliable parameter than GYV for assessment of ARB resistance.

Evolution of critically ill patients with gastroschisis from three tertiary centers.

UNLABELLED: OBJECTIVES AND INTRODUCTION: Gastroschisis is a congenital abdominal wall defect with increasing occurrence worldwide over the past 20-30 years. Our aim was to analyze the morbidity of newborns after gastroschisis closure, with emphasis on metabolic and hydroelectrolyte disturbances in patients at three tertiary university centers. METHODS: From January 2003 to June 2009, the following patient data were collected retrospectively: (A) Background maternal and neonatal data: maternal age, prenatal diagnosis, type of delivery, Apgar scores, birth weight, gestational age and sex; (B) Surgical modalities: primary or staged closure; and (C) Hospital course: levels of serum sodium and levels of serum albumin in the two first postoperative days, number of ventilation days, other postoperative variables and survival. Statistical analyses were used to examine the associations between some variables. RESULTS: 163 newborns were included in the study. Primary closure of the abdominal defect was performed in 111 cases (68.1%). The mean serum sodium level was 127.4 ± 6.7 mEq/L, and the mean serum albumin level was 2.35 ± 0.5 g/dL. Among the correlations between variables, it was verified that hyponatremia and hypoalbuminemia correlated with the number of days on the ventilator but not with the number of days on total parenteral nutrition (TPN); mortality rate correlated with infection. The final survival rate was 85.9%. CONCLUSION: In newborns with gastroschisis, more aggressive attention to hyponatremia and hypoalbuminemia would improve the outcome.

Evolution of critically ill patients with gastroschisis from three tertiary centers

OBJECTIVES AND INTRODUCTION: Gastroschisis is a congenital abdominal wall defect with increasing occurrence worldwide over the past 20-30 years. Our aim was to analyze the morbidity of newborns after gastroschisis closure, with emphasis on metabolic and hydroelectrolyte disturbances in patients at three tertiary university centers. METHODS: From January 2003 to June 2009, the following patient data were collected retrospectively: (A) Background maternal and neonatal data: maternal age, prenatal diagnosis, type of delivery, Apgar scores, birth weight, gestational age and sex; (B) Surgical modalities: primary or staged closure; and (C) Hospital course: levels of serum sodium and levels of serum albumin in the two first postoperative days, number of ventilation days, other postoperative variables and survival. Statistical analyses were used to examine the associations between some variables. RESULTS: 163 newborns were included in the study. Primary closure of the abdominal defect was performed in 111 cases (68.1 percent). The mean serum sodium level was 127.4¡6.7 mEq/L, and the mean serum albumin level was 2.35¡0.5 g/dL. Among the correlations between variables, it was verified that hyponatremia and hypoalbuminemia correlated with the number of days on the ventilator but not with the number of days on total parenteral nutrition (TPN); mortality rate correlated with infection. The final survival rate was 85.9 percent. CONCLUSION: In newborns with gastroschisis, more aggressive attention to hyponatremia and hypoalbuminemia would improve the outcome.

Manometria anorretal em crianças com distúrbios evacuatórios / Anorectal manometry in children with evacuation disturbances

Objetivo: Estudar o impacto da manometria anorretal na avaliação da incontinência fecal e no diagnóstico da doença de Hirschsprung, na Unidade de Gastroenterologia do Departamento de Pediatria (HCRPUSP). Método: Análise retrospectiva dos prontuários de 130 crianças submetidas à manometria anorretal para investigação de constipação intestinal (grupo I) e de incontinência fecal (grupo II), correlacionando os achados manométricos, avaliação ao enema opaco, biópsia retal e evolução clínica. Resultados: No grupo I, o enema opaco foi normal em 55%, a manometria anorretal evidenciou reflexo retoesfincteriano em 80% e a biópsia anorretal mostrou neurônios em 52%. Mediante esses exames e evolução clínica foi possível subdividir as crianças em: com constipação funcional (87), com doença de Hirschsprung (11) e com pseudo-obstrução intestinal (cinco). As 12 crianças restantes tinham estomias, em oito, decorrentes de enterocolite e em quatro, como tratamento provisório de malformação anorretal. Nessas crianças, a avaliação conjunta com enema opaco, manometria e biópsia anorretais possibilitou descartar Hirschsprung. As crianças do grupo II apresentavam meningomielocele (uma), escape fecal (duas), pós-operatório de malformação anorretal (sete), pós-operatório de doença de Hirschsprung (três) e diarréia crônica (duas). A pressão basal anal média em uma criança no pós-operatório de malformação anorretal foi de 50mmHg e, em duas, menos de 20mmHg. Em uma criança com pós-operatório de Hirschsprung a pressão foi de 52mmHg e nas crianças com escape fecal, de 55mmHg. Conclusões: A manometria anorretal é um excelente método na investigação dos distúrbios intestinais na infância. Deve ser utilizada na tentativa da exclusão da doença de Hirschsprung e na avaliação da incontinência fecal, pois, quando é normal, pode, na maioria dos casos, evitar a realização de exames mais invasivos

Lower esophageal sphincter reacts against intraabdominal pressure in children with symptoms of gastroesophageal reflux.

Studies of the effect of increased intraabdominal pressure on the lower esophageal sphincter (LES) are controversial. This study aimed to verify the LES competence against extrinsic abdominal compression in children with and without symptoms of gastroesophageal reflux (GER). Eighteen children ages 6-20 months were evaluated, 11 of them with symptoms of GER (group I) and 7 without symptoms of GER (group II). Manometry of the esophagus, LES, and stomach was performed in all children who underwent extrinsic abdominal compressions of 20, 40, 60, and 80 mm Hg. The pressure gradients in the esophagus, LES, and stomach were measured. The pressure gradient showed a significant difference only in the esophagus after extrinsic abdominal compressions of 60 mm Hg [group I median (range): 7.6mm Hg (2.7-20.0) vs group II: 2.8 mm Hg (1.4-9.6), P < 0.05], and 80 mm Hg [group I median (range): 7.7 mm Hg (3.7-28.9) vs group II: 3.8 mm Hg (1.2-21.1), P < 0.05]. It was concluded that the competence of LES to contain increased intraabdominal pressure might be an important factor in the pathophysiology of GER in children.