RESUMO
BACKGROUND/AIMS: Total parenteral nutrition is responsible for most of the morbidity and mortality of childhood chronic intestinal pseudo-obstruction (CIP). The aim of this study was to determine if there are manometric patterns associated with the success of jejunal feedings in children with CIP. METHODS: Eighteen children with CIP (age range, 1-9 years; mean, 4 years; 11 boys and 7 girls) were studied. All patients required parenteral nutrition or failed to thrive while receiving gastrostomy feedings. All underwent an antroduodenal manometry before surgical placement of a jejunostomy. Continuous drip jejunal feeding with an elemental formula was subsequently initiated. Follow-up after jejunal feeding was 1.6 years (range, 6 months to 4 years). Jejunal manometry was performed 2 months to 1 year after jejunostomy. RESULTS: Jejunal feeding eliminated the need for parenteral nutrition in all 9 patients with migrating motor complex (MMC) and in 3 of 9 patients without MMC (P < 0.01). The MMC was present or absent in both antroduodenal and jejunal manometry in 14 of 18 children (77.7%). In 10 of 18 children (55%), duodenal and jejunal manometry showed similar qualitative abnormalities. CONCLUSIONS: In selected children with CIP who fail gastrostomy feeding, jejunal tube feeding is an alternative to parenteral nutrition. The presence of MMCs is associated with a successful adaptation to jejunal feeding.
Assuntos
Nutrição Enteral , Motilidade Gastrointestinal , Pseudo-Obstrução Intestinal/terapia , Criança , Pré-Escolar , Doença Crônica , Duodeno/fisiopatologia , Feminino , Humanos , Lactente , Pseudo-Obstrução Intestinal/fisiopatologia , Jejunostomia , Jejuno/fisiopatologia , Masculino , ManometriaRESUMO
Serum immunoglobulin A, and G subclasses were measured in patients with ulcerative colitis, Crohn's disease, and in normal controls. Significant differences were noted in elevated total gamma globulin in both disease groups: in elevated IgG1 in ulcerative colitis and elevated IgG2 in patients with Crohn's disease. These differences were not significantly related to disease activity in either disease although higher levels were observed in those with moderate and severe disease.
Assuntos
Imunoglobulina A/sangue , Imunoglobulina G/sangue , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/imunologia , Adolescente , Adulto , Criança , Pré-Escolar , Colite Ulcerativa/sangue , Doença de Crohn/sangue , HumanosRESUMO
We report on four patients with the Smith-Lemli-Opitz (SLO) syndrome who appear to have a defect in cholesterol biosynthesis. The initial results of therapy of one of the patients with cholesterol and bile acids to correct her metabolic abnormalities are described. This finding provides a biochemical marker to help in the diagnosis of this syndrome, may provide insight into the pathogenesis of this disorder, and have therapeutic and prenatal diagnostic implications as well.
Assuntos
Anormalidades Múltiplas/metabolismo , Colesterol/biossíntese , Deficiência Intelectual , Erros Inatos do Metabolismo Lipídico/metabolismo , Oxirredutases atuantes sobre Doadores de Grupo CH-CH , Anormalidades Múltiplas/dietoterapia , Adolescente , Ácidos e Sais Biliares/biossíntese , Criança , Pré-Escolar , Colesterol na Dieta/uso terapêutico , Desidrocolesteróis/sangue , Face/anormalidades , Feminino , Genes Recessivos , Humanos , Lactente , Deficiência Intelectual/dietoterapia , Deficiência Intelectual/metabolismo , Erros Inatos do Metabolismo Lipídico/dietoterapia , Masculino , Microcefalia , Oxirredutases/deficiência , Esteróis/sangue , Síndrome , Ácido Ursodesoxicólico/uso terapêuticoRESUMO
Ulcerative esophagitis may be caused by corrosive agents and by commonly prescribed medications. We report severe esophagitis in five adolescents after ingestion of tetracycline preparations with minimal water immediately before going to bed.
