Cranial osteopathic treatment and stress-related effects on autonomic nervous system measured by salivary markers: A pilot study.

BACKGROUND: Variations in the concentration of salivary alpha amylase (sAA) may indicate a change in the autonomic nervous system functionality. In osteopathic medicine it has long been stated that the osteopathic manipulative treatment (OMT) can modulate the autonomic nervous system. Studies carried out on the compression of the fourth ventricle (CV4) have shown a positive effect in reducing the sympathetic tone. The goal of this pilot study is measuring the physiological response of the sAA levels after CV4 technique. METHODS: 90 subjects were randomly assigned to a sham, a control or a CV4 group. Randomization accounted for sex and score in the STAI-2 (form Y) questionnaire. Each subject completed the STAI-1 (form Y) questionnaire to evaluate the anxiety of the moment. sAA activity and saliva flow rate were measured. Saliva was collected before, immediately after and 30 min after treatment. RESULTS: Within group analysis revealed that sAA activity increased significantly immediately after the technique application only in the CV4 group (p = 0,05). Between groups analysis show a significant difference of the sAA activity in the CV4 group respect the control group (p < 0,05), but no significant difference between CV4 and sham group (p > 0,05). The effect in the CV4 group after the intervention is highly variable and appeared to be related to the level of stress measured with the STAI-Y1 questionnaire (p = 0,002). CONCLUSIONS: This study shows a positive effect of the CV4 procedure on sAA activity even if not significantly different from the sham procedure, probably due to the confounding effect of stress variability between groups.

[Allergic colitis in exclusively breast-fed infants]. / Colitis alérgica en lactantes exclusivamente amamantados al pecho.

INTRODUCTION: Eosinophilic colitis is induced by antigens present in cow's milk proteins in formula or human milk. In the last few years, an increasing number of cases have been diagnosed in exclusively breast-fed infants. PATIENTS AND METHODS: We performed a retrospective study of 13 infants diagnosed with allergic colitis in our unit between January 1997 and January 2004. All the infants had been exclusively breast-fed. RESULTS: In all patients, initial symptoms were digestive (12 with mucus and bloody stools). Onset of symptoms occurred at 0-3 months in 77 %. Laboratory data of the allergic compound were negative. The main locations were the descending and sigmoid colon (75 %). Biopsy demonstrated acute inflammation, with neutrophil infiltration and an increase in eosinophils. In all patients, initial treatment consisted of exclusion of cow's milk proteins from the mother's diet. Ten of the 13 patients showed no improvement, requiring exclusive administration of protein-free hydrolyzate. In 3 infants, breastfeeding was maintained (breastfeeding without cow's milk proteins plus hydrolyzate). CONCLUSIONS: Diagnosis of eosinophilic colitis is based on exclusion of other causes of specific colitis and typical endoscopic and ultrastructural findings. Moreover, a satisfactory response to dietary treatment must be demonstrated. This diagnosis should be considered in breast-fed infants with rectal bleeding without involvement of general health status.

Colitis alérgica en lactantes exclusivamente amamantados al pecho / Allergic colitis in exclusively breast-fed infants

Introducción: La proctocolitis eosinofílica está inducida por antígenos presentes en las proteínas de leche de vaca contenidas en las fórmulas o en la leche humana y, en los últimos años, se describen cada vez más casos en lactantes pequeños alimentados exclusivamente con la leche materna. Pacientes y métodos: Se presenta un estudio retrospectivo de los 13 casos de colitis alérgica diagnosticados en nuestra unidad entre enero de 1997 y enero de 2004, todos ellos lactantes que estaban recibiendo exclusivamente leche materna. Resultados: La sintomatología de inicio fue siempre la digestiva (12 debutaron con heces con moco y hebras de sangre) y en el 77 % de los casos apareció entre los 0 y los 3 meses de edad. Los datos analíticos del componente alérgico fueron negativos. Las lesiones se localizaron, principalmente (75 %), en las zonas descendente y sigma del colon. La anatomía patológica demostró datos inflamatorios agudos, con infiltración por polimorfonucleares y aumento de eosinófilos. En todos los pacientes se inició tratamiento excluyendo la leche de vaca y sus derivados en la dieta de la madre. En 10/13 no se evidenció mejoría, por lo que requirieron administración exclusiva de hidrolizado extenso de proteínas. En 3 niños se mantuvo lactancia mixta (sin proteínas vacunas 1 hidrolizado). Conclusiones: El diagnóstico exige exclusión de otras causas de colitis específica y hallazgos endoscópicos y anatomopatológicos característicos; además, se debe demostrar respuesta adecuada al tratamiento dietético. Se debe pensar en esta patología al afrontar el diagnóstico de lactantes amamantados que presenten sangrado rectal sin afectación del crecimiento o del estado general

Introduction: Eosinophilic colitis is induced by antigens present in cow's milk proteins in formula or human milk. In the last few years, an increasing number of cases have been diagnosed in exclusively breast-fed infants. Patients and methods: We performed a retrospective study of 13 infants diagnosed with allergic colitis in our unit between January 1997 and January 2004. All the infants had been exclusively breast-fed. Results: In all patients, initial symptoms were digestive (12 with mucus and bloody stools). Onset of symptoms occurred at 0-3 months in 77 %. Laboratory data of the allergic compound were negative. The main locations were the descending and sigmoid colon (75 %). Biopsy demonstrated acute inflammation, with neutrophil infiltration and an increase in eosinophils. In all patients, initial treatment consisted of exclusion of cow's milk proteins from the mother's diet. Ten of the 13 patients showed no improvement, requiring exclusive administration of protein-free hydrolyzate. In 3 infants, breastfeeding was maintained (breastfeeding without cow's milk proteins plus hydrolyzate). Conclusions: Diagnosis of eosinophilic colitis is based on exclusion of other causes of specific colitis and typical endoscopic and ultrastructural findings. Moreover, a satisfactory response to dietary treatment must be demonstrated. This diagnosis should be considered in breast-fed infants with rectal bleeding without involvement of general health status

Disfagia persistente en una niña de 9 años / Persistent dysphagia in a 9-year-old girl

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[Influence of energy expenditure on childhood obesity]. / Influencia del gasto energético en la obesidad infantil.

OBJECTIVES: To study differences in resting energy expenditure (REE) according to its determining factors (sex, weight, body fat mass, lean body mass) and in the oxidation of energy substrates in obese and non-obese children. PATIENTS AND METHODS: We studied 71 children (39 obese and 32 non-obese) aged from 4.1 to 13.6 years. The male/female ratio was 34/37. Energy expenditure (EE) was measured by using open circuit indirect calorimetry. The oxidation of energy substrates was calculated from oxygen consumption, carbon dioxide production, and urinary nitrogen excretion from urea. Body composition was determined by anthropometry. RESULTS: REE (kcal/day), adjusted for anthropometric parameters and body composition, was higher in boys than in girls. The absolute REE was significantly higher in obese than in non-obese children (1512.82 6 234.47 vs 1172.59 6 190.20) and was higher or the same when adjusted for its determinants. Compared with the non-obese group, the obese group presented a significantly higher percentage of fat oxidation (57.15 6 10.68 vs 51.08 6 13.61, p 5 0.04), a lower percentage of carbohydrate oxidation (30.10 6 9.85 vs 36.34 6 13.61, p 5 0.03) and a lower respiratory quotient (0.79 6 0.03 vs 0.82 6 0.04, p 5 0.02). No differences were found between male and female subjects in the percentages of carbohydrate, fat, and protein oxidation. CONCLUSIONS: We obtained the followings conclusions: a) When adjusted for anthropometric measurements and body composition, REE was significantly higher in boys than in girls; b) REE was higher in obese than in non-obese children, after adjustment for lean body mass; and c) Compared with the control group, obese children presented a higher percentage of fat oxidation, a lower percentage of carbohydrate oxidation, and a lower respiratory quotient.

Influencia del gasto energético en la obesidad infantil / Influence of energy expenditure on childhood obesity

Objetivos Estudiar las diferencias en el gasto energético en reposo (GER) en función de sus determinantes (sexo, peso, masa grasa, masa magra) y la oxidación de los sustratos energéticos entre niños obesos y no obesos. Pacientes y métodos Se ha estudiado una muestra de 71 niños, 39 obesos y 32 controles, con rango de edad entre 4,1 y 13,6 años, de los cuales 37 eran mujeres y 34 varones, a los que se realiza medida del gasto energético mediante calorimetría indirecta de circuito abierto. La oxidación de sustratos se calculó a partir del consumo de oxígeno, producción de anhídrido carbónico y excreción de nitrógeno ureico urinario. Se determinó la composición corporal por antropometría. Resultados El GER (kcal/día) ajustado en función de los parámetros antropométricos y de composición corporal es superior en niños que en niñas. El GER en valor absoluto es significativamente superior en los obesos (1.512,82 234,47 frente a 1.172,59 190,20), y al expresarlo en función de sus determinantes, sigue siendo mayor en los obesos o se iguala en ambos grupos. Los obesos presentan mayor porcentaje de oxidación de grasas (57,15 10,68 frente a 51,08 13,61; p 0,04), menor porcentaje de oxidación de hidratos de carbono (30,10 9,85 frente a 36,34 13,61; p 0,03) y menor cociente respiratorio (0,79 0,03 frente a 0,82 0,04; p 0,02). No existen diferencias en los porcentajes de oxidación de hidratos de carbono, grasas y proteínas según el sexo. Conclusiones Del estudio se han extraído las siguientes conclusiones: a) el GER ajustado en función de los parámetros antropométricos y de composición corporal es significativamente superior en el sexo masculino que en el femenino; b) el GER es superior en los obesos, y sigue siéndolo al estandarizarlo en función de la masa corporal magra, y c) los niños obesos presentan mayor porcentaje de oxidación de grasas, menor porcentaje de oxidación de hidratos de carbono y un cociente respiratorio menor que los niños no obesos. (AU)

Prescribing second-generation antipsychotics and the evolving standard of care in Italy.

The present study was carried out to investigate the routine use of second-generation antipsychotic drugs in the Italian psychiatric care system. Seven outpatient psychiatric services enrolled a consecutive case series of patients who were being treated, or had started treatment, with clozapine, olanzapine, risperidone, or quetiapine. Information on sociodemographic and clinical variables, current psychotropic drug use, side-effects and past use of typical drugs was collected. In addition, patient symptoms and functional status were evaluated by the Health of the Nation Outcome Scale. Patients receiving off-label prescribing of second-generation antipsychotics were identified. A total of 209 patients were collected. In comparison with patients receiving other second-generation antipsychotics, living in residential facilities, unemployment, long psychiatric histories, and problems with activities of daily living and living conditions were more common in clozapine-treated patients. Nearly 80 % of patients receiving clozapine had schizophrenia compared to less than 50 % of those receiving other second-generation antipsychotics. Overall, 109 patients (52 %) received off-label prescriptions of second-generation antipsychotic drugs. This survey indicates that clozapine was mostly reserved for severe cases and poor responders; the high rate of off-label prescriptions highlights the gap existing between recommendations derived from randomised clinical trials and the current use of drugs.

[Metastatic Crohn's disease in childhood]. / Enfermedad de Crohn metastásica.

Crohn's disease (CD) is an intestinal inflammatory disease of unknown origin that is sometimes associated with cutaneous manifestations. These skin lesions are usually nonspecific (erythema nodosum, erythema multiforme and pyoderma gangrenosum) and should be differentiated from the cutaneous lesions corresponding to the typical histological pattern of CD; most of these extend directly from the involved bowel. Noncaseating granulomatous infiltration in skin anatomically distant from areas of gastrointestinal CD and separated by normal skin is extremely rare. This entity, known as metastatic Crohn's disease, can be the first symptom of CD or even more unusually can appear during the course of the disease.We report the case of a 9-year-old boy, previously diagnosed with ileocolic and perianal CD, who had been receiving treatment with mesalazine, prednisone and 6-mercaptopurine for 3 years. He presented with swelling of the penis and scrotum of 2 weeks' evolution, without any other symptoms. Testicular ultrasound showed thickening of the scrotal wall and increased flux at this site. Skin biopsy showed noncaseating granulomas. Results of special staining techniques were negative for the presence of microorganisms. The prednisone dose was increased and metronidazole was added, with noticeable improvement in the lesions. Due to reappearance of cutaneous lesions when the prednisone dose was reduced, the patient currently receives maintenance treatment.

Hematoma duodenal intramural: inusual complicación de la biopsia intestinal mediante cápsula / Intramural duodenal hematoma: unusual complication of the intestinal biopsy by capsule

La biopsia intestinal es una técnica de gran interés para el estudio del niño con síndrome de malabsorción.La biopsia mediante succión usando cápsula es un método muy extendido y de fácil realización.La aparición de complicaciones es inusual, las más frecuentes son el sangrado intraluminal y la perforación. El hematoma duodenal intramural es una complicación extremadamente rara. Presentamos un caso de obstrucción intestinal secundaria a hematoma duodenal intramural después de una biopsia intestinal peroral mediante cápsula pediátrica de Watson-Crosby.La ecografía abdominal ha simplificado el diagnóstico.La mayoría de pacientes responden bien al tratamiento conservador, reservándose el tratamiento quirúrgico a casos muy concretos. Con este artículo queremos alertar sobre la posibilidad de esta rara complicación.Se recomienda un seguimiento cuidadoso de estos pacientes después de la biopsia (AU)

Long term efficacy of paroxetine in major depression: A study with plasma levels.

Depressive disorders can be regarded as recurrent and chronic conditions that may reduce the quality of life and work output of patients. Data on the long-term efficacy of paroxetine appear to indicate that it is an effective maintenance treatment. Our aim was to measure paroxetine concentrations in plasma in order to optimize its clinical efficacy and tolerability during long-term treatment. We studied 35 patients aged 23-70 years, suffering from Major Depressive Disorder (recurrent). These patients received 10-50 mg of paroxetine once a day for one year; they were evaluated at baseline, after 2 weeks and then after 1,2,6,9 and 12 months by BPRS, HRS-D and HRS-A rating scales, and at the same time, any side-effects were assessed and samples for paroxetine plasma determination were also collected. Results confirmed the efficacy and tolerability of paroxetine for long-term treatment. We observed a curvilinear relationship between plasma paroxetine levels and improvement on the HRS-D with greater clinical amelioration at plasma levels between 20 and 70 ng/ml.

[Investigation of protein-losing enteropathy in pediatric patients]. / Investigación de la pérdida entérica de proteínas en pacientes pediátricos.

OBJECTIVE: Our objective was to investigate enteric los of proteins in a group of selected patients, which frequently is not taken into account in the clinical management of these patients. PATIENTS AND METHODS: We included 20 healthy children (group I), 10 pediatric patients with heart disease (group II) and 20 pediatric patients with gastrointestinal disease (group III). They were selected because a high percentage of them had high right heart chamber pressure and/or lymphatic anomalies or inflammation and/or ulceration of the gastrointestinal mucosa. A double study method was performed, including excretion of fecal alpha-1-antitrypsin and intestinal clearance of alpha-1-antitrypsin. RESULTS: A high correlation between both methods (r = 0.7542, p < 0.001) was found. Normal values were obtained for the excretion of fecal alpha-1-antitrypsin (< 1.6 mg/g of dry feces) and for clearance (< 26.5 ml/day) in group I. Protein-losing enteropathy was diagnosed in 60% of cardiac patients and 35% of patients with gastrointestinal disease when applying the method of fecal alpha-1-antitrypsin excretion and in 50% and 40%, respectively, when using the clearance method. There is a high correlation between the clearance and plasma protein level (r = -0.7162, p < 0.001 for albumin, r = -0.5239, p < 0.01 for transferrin, r = -0.4609, p < 0.05 for prealbumin). The regression line crosses the albumin concentration of 3 g/dl when the clearance is 176 ml/day, a similar result to that seen in adult patients. CONCLUSIONS: Protein-losing enteropathy is detected in a high proportion of pediatric patients affected by cardiac or gastrointestinal disease. There is a close correlation between fecal excretion and intestinal clearance of alpha-1-antitrypsin.

Duodenal stenosis from intramural cystic annular pancreas.

A case of annular pancreas presenting with duodenal obstruction due to overfilling of a large intramural duodenal cyst is reported. At 30 years of age, this man was an alcoholic with repeated attacks of pancreatitis which produced the enlargement of an annular pancreas and the development of a cyst probably through blocking of an aberrant duct. The surgical operation consisted of simply removing part of the external cyst wall and outer anterior layer of the duodenum. A postoperative acalculous cholecystitis necessitated subsequent cholecystectomy. Four years later, the patient had to be operated on for duodenal stenosis due to recurrent duodenal ulcers.

[Alagille's syndrome. Clinical and histo-pathologic study]. / Le syndrome D'alagille. Etude clinique et histo-pathologique.

Alagille 's syndrome, described in 1970, associates a chronic intrahepatic cholestasis (hypoplasia of the interlobulary biliary ducts), vertebral and visceral malformations, retarded physical, mental and sexual development and neonatal jaundice. A series of cutaneous manifestations are reviewed in their clinical, histological and ultrastructural aspects. Its relation with the zinc deficiency syndrome is discussed.