[Small bowel overgrowth: a frequent complication after abdominal surgery in newborns]. / Sindrome dell'intestino infetto: complicanza frequente dopo chirurgia addominale nel neonato.

BACKGROUND/PURPOSE: Surgery for congenital or acquired gastroenterological disorders, and particularly that associated with short bowel, is not infrequently complicated by Small Bowel Bacterial Over growth (SBBO). Aim of this study is to evaluate the clinical course of children undergoing bowel surgery in the newborn period, assessing the development of SBBO and the response to intensive treatment with a "bowel cocktail" of gentamycin, metronidazole and cholestyramine. METHODS: 17 children with various conditions were studied clinically and by Breath Hydrogen Test (fasting and after glucose). 14 children underwent more than one procedure. All children were treated with overall "bowel cocktail" of gentamycin, metronidazole and cholestyramine. RESULTS: 5 children recovered after one course of treatment and 11 children relapsed at least once and required further courses of therapy. One child died from TPN related liver failure and another following a liver and small bowel transplant for short bowel syndrome. A third child required total intestinal tube splinting according to Sauer and another one required a tapering of the preatretic enlarged jejunal loop. CONCLUSIONS: Our study suggests that children undergoing bowel surgery in the neonatal period and those having more than one procedure are at greater risk of developing small bowel bacterial overgrowth postoperatively. Interestingly, loss of the ileocecal valve was not associated with an increased risk of bacterial overgrowth.

[Chronic idiopathic gastric volvulus in children]. / Il volvolo gastrico cronico idiopatico in età pediatrica.

OBJECTIVE: We report clinical, radiograpic and instrumental data about 18 cases of gastric chronic idiopathic volvulus observed since 1997 to june 2000. METHOD: All cases diagnosed by barium meal, performed for vomiting or after a pHmetric esophageal monitoring, in cases of atipical symptoms of gastroesophageal reflux disease. RESULTS: All patients underwent a conservative treatment (antireflux position and procinectics): 5 recovered after 1 year of treatment and 13 were operated on because they did not improve during medical therapy or relapsed after the end of conservative treatment. CONCLUSION: Abnormal position of the stomach is not an absolute indication for surgical treatment. When medical treatment does not obtain improvement in symptoms, surgical option has to be discussed.

Prevalence of celiac disease in Argentina: screening of an adult population in the La Plata area.

OBJECTIVES: Up to now, the epidemiological characteristic of celiac disease among adults in South America remains unknown. The present prospective screening was designed to determine the prevalence of celiac disease in adults from the general population in an urban area of Argentina. METHODS: Between January. 1998, and May, 2000, all couples attending a centralized laboratory for an obligatory prenuptial examination in the La Plata area were offered participation in a screening program for celiac disease. The study included 2000 subjects (996 women; median age 29 yr, range 16-79 yr). All individuals completed a clinical questionnaire at the time that serum samples were obtained. A three-step screening protocol was used, as follows: 1) all samples were tested for antigliadin antibodies (AGAs) (type IgA and IgG); 2) samples that were IgA AGA positive were tested for antiendomysial antibody (EmA type IgA); samples that were positive for AGA-G but negative for IgA AGAs were tested for total IgA serum levels and EmA type IgG; and 3) subjects who were EmA-positive were referred for intestinal biopsy. RESULTS: At the end of the screening we detected 10 subjects who were EmA-A positive and two others who were IgA-deficient (both were EmA-G positive). Up to now, 11 of the 12 subjects (including nine EmA-positive and two IgA-deficient subjects) had endoscopic intestinal biopsies showing the characteristic celiac histology. The remaining EmA-positive individual was considered to be affected by celiac disease. The overall prevalence assessed was 1:167 (6.0 x 1000 subjects; 95% CI = 3.1-10.5). Eight of the 12 (67%) subjects were female (1:124; 8.0 x 1000; 95% CI = 3.5-15.8) and four (33%) were male (1:251; 4.0 x 1000; 95% Cl = 1.1-10.2). Although eight new patients were considered to be asymptomatic, three presented with a subclinical course and one was classically symptomatic. Only one patient had been previously diagnosed with celiac disease. CONCLUSIONS: Our screening protocol showed a very high prevalence of celiac disease for an urban area of Argentina that is ethnically similar to 90% of the general population of the country. The prevalence among women was double that for men, and the heterogeneous clinical picture of new patients showed predominance of asymptomatic cases.

Tissue transglutaminase antibodies in celiac disease: assessment of a commercial kit.

OBJECTIVE: Tissue transglutaminase was identified as the autoantigen eliciting endomysial antibody. A homemade enzyme-linked immunosorbent assay (ELISA)-based test was recently developed to determine quantitative titers of IgA antitissue transglutaminase antibody. Our objective in this study was to assess the suitability of a newly developed commercial kit for quantitative determination of antibody in patients with untreated celiac disease. MATERIALS: We tested serum samples from 79 untreated celiac patients, 42 healthy blood donors, and 18 patients with nonceliac intestinal disorders evaluated in two different centers. Samples were tested for antitissue transglutaminase, and antiendomysial and antigliadin antibodies in the center where diagnosis was performed. To assess interlaboratory variability of methods, 24 samples randomly selected were blindly tested in both centers. Antitissue transglutaminase antibodies were determined using a commercial kit (INOVA Diagnostics, Inc., San Diego, CA). RESULTS: Untreated celiac patients had significantly higher titers of antitissue transglutaminase than healthy and disease controls (p < 0.00001). According to the cut-off provided by the manufacturers (20 AU/mL), overall sensitivity was 92% (85% for one center and 100% for the other) and specificity was 98% (100% and 95%, respectively). Antiendomysial antibody was 86% sensitive and 100% specific. Discordance between antitissue transglutaminase and antiendomysial antibodies was detected in 13% of patients. Although two antitissue transglutaminase-negative cases had a positive antiendomysial antibody, the inverse situation was found in eight cases. A blind determination of antitissue transglutaminase on the same samples evidenced a good agreement (kappa statistic: 0.66) between both centers when assessment was qualitative (based on the decision of positive or negative). Although correlation of titers for both determinations was highly significant (r: 0.902, p < 0.00001), a very wide interlaboratory variability (median: 50%) was detected when absolute values were considered. CONCLUSIONS: The quantitative determination of antitissue transglutaminase using a commercial kit was highly sensitive and specific for detection of celiac disease. We observed an incomplete overlapping with antiendomysial antibody. The very high variability of values between laboratories still remains to be solved so as to propose the commercial ELISA assay for the screening of celiac disease.

Balance nitrogenado en el paciente crítico con nutrición enteral / Nitrogen balance in critical patients with enteral feeding

La evaluación del balance nitrogenada en pacientes criticos y en aquellos que reciben soporte nutricional se realiza con la estimación de las pérdidas de nitrógeno en orina midiendo en nitrogeno ureico urinario (NUU), el que representa la mayor parte de las plérdidas nitrogenadas. Dado que contamos con la posibilidad de realizar la determinación de nitrógeno total urinario (NTU) quisimos evaluar el impacto del soporte nutricional en el balance nitrogenado de los pacientes críticos. Objetivos: 1. evaluar el balance nitrogenado de los pacientes internados en terapia intensiva (UTI). 2. estudiar la evaluación del balance nitrogenado en pacientes ayunados y su evolución en el curso del soporte nutricional ... (AU)

Balance nitrogenado en el paciente crítico con nutrición enteral / Nitrogen balance in critical patients with enteral feeding

La evaluación del balance nitrogenada en pacientes criticos y en aquellos que reciben soporte nutricional se realiza con la estimación de las pérdidas de nitrógeno en orina midiendo en nitrogeno ureico urinario (NUU), el que representa la mayor parte de las plérdidas nitrogenadas. Dado que contamos con la posibilidad de realizar la determinación de nitrógeno total urinario (NTU) quisimos evaluar el impacto del soporte nutricional en el balance nitrogenado de los pacientes críticos. Objetivos: 1. evaluar el balance nitrogenado de los pacientes internados en terapia intensiva (UTI). 2. estudiar la evaluación del balance nitrogenado en pacientes ayunados y su evolución en el curso del soporte nutricional ...

Congenital reflux nephropathy: a follow-up of 108 cases diagnosed perinatally.

OBJECTIVE: To determine: (i) the proportion of vesicoureteric reflux (VUR) associated with congenital renal damage and whether it can be severe enough to cause renal impairment from birth: (ii) to evaluate the distribution of males and females affected; and (iii) to describe the course of congenital damage in the first years of life. PATIENTS AND METHODS: A total of 108 children (76 male and 32 female, M:F 2.3:1), whose VUR was diagnosed before any infection, were followed from birth for a mean (range) of 4.3 (1-10) years. Renal damage was defined by serum creatinine concentration, creatinine clearance and renal imaging (ultrasonography and renal scintigraphy) performed within the first month of life and periodically thereafter. RESULTS: Of the 108 children, 58 had bilateral and 50 unilateral reflux (total number of refluxing units, 166). High-grade VUR (grade > or = 4) was found in 96 (58%) refluxing renal units (RRUs). Males had a prevalence of bilateral severe (> or = grade 4) reflux (M:F 5.2:1), while in those wit unilateral VUR, the M:F ration was 1.5:1. At birth, mild to moderate damage was present in 56 (36%) RRUs and only associated with VUR of grade > or = 3. Bilateral reflux of grade > or = 4 was associated with congenital moderate/severe renal failure in nine neonates (seven males). In infants with grade > or = 4 VUR who underwent surgical correction, VUR resolved in 92% of cases. In infants with VUR of grade > or = 4 followed medically, the reflux spontaneously resolved in 42% and ameliorated in 16% after 18 months. Serial renal scans during the follow-up showed no progression of renal damage. CONCLUSIONS: VUR diagnosed at birth on prenatal ultrasonography is associated with congenital damage, with males affected more often than females. The damage involves both kidneys in a consistent proportion and is an important cause of chronic renal impairment from birth. It does not progress in the first years of life if infections are prevented. It is suggested that males with this condition may constitute a major group at risk of developing chronic renal failure in later life.

[An unusual case of macroscopic hematuria in pediatric age]. / Un caso insolito di ematuria macroscopica in età pediatrica.

An unusual case of macroscopic hematuria in a 14 year old boy is presented. At the time of the first hospital admission, no urinary tract infection could be demonstrated, in spite of the associated symptoms of stranguria and dysuria. At ultrasound examination, only a mild thickening of the upper bladder wall was detected, and cystoscopy showed a huge oedema and inflammation of the mucosal layer. The biopsy of the bladder was characterized by a definite eosinophilic infiltration; due to this particular hystologic pattern, the diagnosis of eosinophilic cystitis was made. In the following months, the boy did not improve. Recurrent hematuria occurred, and a pseudo-polypoid mass in the inner bladder wall was detected at ultrasonography. A limited resection of the vesical dome was performed, to remove completely the mass. The hystologic examination showed Schistosoma Haematobium eggs in the bladder wall, with a typical granulomatous reaction. The post-operative course was uneventful, and the child was completely cured after Praziquantel treatment. The Authors underline the need to take into account Schistosomiasis in cases of hematuria, particularly when this symptom affects boys coming from countries where Bilharziasis is endemic.

Lípidos séricos y evaluación antropométrica en adultos jóvenes / Serum lipids and anthropometric evaluation in young adults

Se estudiaron en forma consecutiva y bajo su consentimiento 76 sujetos aparentemente sanos (38 hombres y 38 mujeres no embarazadas), de 18 a 40 años de edad (media 26,7 ñ 4,7) que concurrieron a efectuar un examen prenupcial, para determinar los lípidos séricos y relacionarlos con el sexo, la edad y los resultados de mediciones antropométricas para la evaluación indirecta del estado nutricional. Se les realizó un cuestionario, se obtuvo el peso, la talla, se midieron los perímetros de la muñeca, el tórax, la cintura y la cadera, se obtuvo el pliegue subcutáneo tricipital y subescapular. Se calculó el Indice de Masa Corporal o "body mass index" (BMI), el peso ideal y el peso relativo, el índice cintura/tórax (C/T) y cintura/cadera (C/C), se dosaron la colesterolemia, el HDL-Colesterol y los Triglicéridos por métodos enzimáticos. Se calculó el LDL-Colesterol (Fórmula de Friedewal) y el índice Col/HDL-col. Resultados: 1) Promedios: Col: 180,7 ñ 43,4 mg/dl, HDL-Col: 47,3 ñ 14,3 mg/dl, TG: 81,1 ñ 61,0 mg/dl, LDL-Col: 116,7 ñ 38,0 mg/dl, IR: 4,03 ñ 1,7, BMI: 23,5 ñ 3,5, PR: 102,4 ñ 10,5, C/T: 0,92 ñ 0,07, C/C: 0,80 ñ 0,08, Tri: 17,7 ñ 7,0 mn y Esc: 15,3 ñ 5,5 mn. Se detectó un 18,42 por ciento de los sujetos que tenían criterios BMI y de peso relativo de obesidad. El 30,26 por ciento de la muestra presentó un aumento del Col, un descenso de HDL-Col y un índice Col/HDL-Col elevado, en este último con un franco predominio de los varones. La frecuencia de hipertrigliceridemia fue baja (13,15 por ciento). Los índices antropométricos utilizados (BMI, PR, C/T, C/C) excepto con el Colesterol (que sólo se vinculó al C/C), mostraron una buena correlación con los lípidos séricos. La edad presentó una fuerte asociación con la colesterolemia pero no con el HDL-Col. Hubo diferencias entre sexos para las variables estudiadas, menos para el C/T y el pliegue escapular. No se detectó ninguna persona con C/C bajo (biotipo "fémoro-glúteo o ginoide) e IR elevado, lo cual plantea el interrogante si esta disposición de la grasa del cuerpo no representa una manifestación de "protección" para que no se desarrolle una dislipemia

Lípidos séricos y evaluación antropométrica en adultos jóvenes / Serum lipids and anthropometric evaluation in young adults

Se estudiaron en forma consecutiva y bajo su consentimiento 76 sujetos aparentemente sanos (38 hombres y 38 mujeres no embarazadas), de 18 a 40 años de edad (media 26,7 ñ 4,7) que concurrieron a efectuar un examen prenupcial, para determinar los lípidos séricos y relacionarlos con el sexo, la edad y los resultados de mediciones antropométricas para la evaluación indirecta del estado nutricional. Se les realizó un cuestionario, se obtuvo el peso, la talla, se midieron los perímetros de la muñeca, el tórax, la cintura y la cadera, se obtuvo el pliegue subcutáneo tricipital y subescapular. Se calculó el Indice de Masa Corporal o "body mass index" (BMI), el peso ideal y el peso relativo, el índice cintura/tórax (C/T) y cintura/cadera (C/C), se dosaron la colesterolemia, el HDL-Colesterol y los Triglicéridos por métodos enzimáticos. Se calculó el LDL-Colesterol (Fórmula de Friedewal) y el índice Col/HDL-col. Resultados: 1) Promedios: Col: 180,7 ñ 43,4 mg/dl, HDL-Col: 47,3 ñ 14,3 mg/dl, TG: 81,1 ñ 61,0 mg/dl, LDL-Col: 116,7 ñ 38,0 mg/dl, IR: 4,03 ñ 1,7, BMI: 23,5 ñ 3,5, PR: 102,4 ñ 10,5, C/T: 0,92 ñ 0,07, C/C: 0,80 ñ 0,08, Tri: 17,7 ñ 7,0 mn y Esc: 15,3 ñ 5,5 mn. Se detectó un 18,42 por ciento de los sujetos que tenían criterios BMI y de peso relativo de obesidad. El 30,26 por ciento de la muestra presentó un aumento del Col, un descenso de HDL-Col y un índice Col/HDL-Col elevado, en este último con un franco predominio de los varones. La frecuencia de hipertrigliceridemia fue baja (13,15 por ciento). Los índices antropométricos utilizados (BMI, PR, C/T, C/C) excepto con el Colesterol (que sólo se vinculó al C/C), mostraron una buena correlación con los lípidos séricos. La edad presentó una fuerte asociación con la colesterolemia pero no con el HDL-Col. Hubo diferencias entre sexos para las variables estudiadas, menos para el C/T y el pliegue escapular. No se detectó ninguna persona con C/C bajo (biotipo "fémoro-glúteo o ginoide) e IR elevado, lo cual plantea el interrogante si esta disposición de la grasa del cuerpo no representa una manifestación de "protección" para que no se desarrolle una dislipemia (AU)

Solid and cystic tumor of the pancreas--case report.

Pancreatic tumors are rarely present in childhood. The authors present a case of papillary-cystic tumor in a 13-year-old girl, treated by partial pancreatoduodenectomy, with preservation of the pylorus. The histologic pattern was of a papillary cystic tumor without evident atypical nuclei. One year after operation, the girl is well without any finding of disease.

[Intestinal resection in children: personal experience and suggested follow-up. Preliminary results]. / Resezioni intestinali in età pediatrica: esperienza personale e proposta di follow-up. Risultati preliminari.

In the paediatric field cases of patients subjected to massive intestinal resection (M.I.R.) are more and more frequent; this survival of individuals with a small intestine shorter than 30 centimeters is not to be considered exceptional. Without going as far as such extreme limits of short residual intestine, intestinal resections contributed to create a new pathology represented by those patients who, once they have been subjected to particularly extended intestinal resections, need a particularly responsible nutritional therapy, sometimes with very long hospitalizations. The present study is to appraise the nutritional parameters and the residual absorption capacity of a group of patients in pediatric age subjected to intestinal resection, in order to draw up a record enabling to monitor, as time goes on, the intestinal functionality of those patients and to observe as early as possible the consequences of an alteration of intestinal physiology while creating the premisis for appropriate measures of nutritional supplementing.

[Massive intestinal resection in the newborn: nutritional and feeding problems]. / Resezioni intestinali massive nel neonato: problemi di nutrizione e di alimentazione.

Authors present their experience about nutritional treatment of short bowel syndrome in newborns. Their results seem to demonstrate that right approach to this problem is to start enteral nutrition as soon as possible, using mainly human milk and polimeric nutritional solutions. There are several experimental evidences that this kind of nutritional approach promote intestinal adaptation following massive intestinal resections.

[Neonatal scrotal hemorrhage caused by post-traumatic hemoperitoneum]. / Emorragia scrotale neonatale da emoperitoneo post-traumatico.

The Authors describe a case of neonatal scrotal hematoma due to post-traumatic intra-abdominal hemorrhage. Differential diagnosis with testicular torsion and other causes of neonatal acute scrotum is considered and discussed.

[Our experience in the subject of gastroesophageal reflux disease]. / La nostra esperienza in tema di malattia da reflusso gastroesofageo.

From January 1st, 1983 to March 31st, 1988, 66 children with GER were tested with barium esophagogram, esophageal pH monitoring and esophagoscopy. A medical therapy was given to 49 children and 46 had a clinical improvement; 13 were operated. Early diagnosis is very important to prevent complications: in fact our data show that older children have the worst complications, while infants with GER and severe esophageal pH monitoring have only I-II grade esophagitis.