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1.
Nat Biotechnol ; 34(1): 55-63, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26744983

RESUMO

The PROPATRIA (Probiotics in Pancreatitis Trial) study was a multicenter, double-blind, placebo-controlled clinical trial that aimed to reduce infectious complications in patients with predicted severe acute pancreatitis by the enteral use of a multispecies probiotic preparation. An unprecedented 24 of 152 patients (16%) in the group receiving probiotics died versus 9 of 144 (6%) in the placebo group. This high mortality rate in the probiotic-treated group contrasts strongly with observations from a previous smaller study and from our observations regarding the effects of abundant intestinal lactobacilli in patients with short small bowel (SSB) syndrome. We argue here that a lethal combination of mainly proteolytic pancreas enzymes and probiotic therapy resulted in the high mortality rate of the PROPATRIA trial and that elevated levels of lactic acid produced by bacterial fermentation of carbohydrates were a key contributing factor. We suggest that probiotic therapy may not be counter-indicated for the prevention of secondary infections associated with acute pancreatitis, provided that future clinical studies (i) start probiotic therapy immediately after first onset of disease symptoms, (ii) limit the supply of fermentable carbohydrates, (iii) prevent bacterial (over)growth of patient's own intestinal flora and (iv) massively increase the dose of probiotic bacteria.


Assuntos
Probióticos , Doença Aguda , Doença Crônica , Método Duplo-Cego , Humanos , Pancreatite/terapia , Placebos
2.
Injury ; 40(8): 901-4, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19524904

RESUMO

INTRODUCTION: The clinical presentation of Complex Regional Pain Syndrome type I (CRPS I) in children differs compared to the presentation in adults. Reported results of treatment of CRPS I in children are usually more favourable and seem better than the reported treatment of adults with CRPS I. We investigated the quality of life (QoL) in adults who have been treated for childhood-onset CRPS I. METHODS: We performed a retrospective chart review on signs, symptoms and treatment of all patients, seen and treated for CRPS I in childhood (age <16 years). At one time point a survey was sent by mail to all adult patients with onset CRPS I in childhood with a postal reminder after one month. The first part of the survey consisted of questions focused on the experience of chronic pain and other current complaints in the affected extremity. The second part consisted of a generic-health-related quality of life instrument (SF-36). RESULTS: Forty-two patients (75%) responded to our survey. The median follow-up period was 12 years (SD 4.7; range 2-22). Fifty-two percent of all patients complained about pain at the time of follow-up. Of the 12 symptoms and signs, 4 are improved, 1 is worse and the remainder are unchanged. Fifteen patients experienced one or more documented relapses. General health and physical functioning (2 out of 8 scales on the SF 36) were lower in patients compared to those of the literature. CONCLUSION: In contrast to the literature, the prognosis of childhood-onset CRPS I seems less favourable than usually reported, and is comparable to the prognosis of the adult-onset CRPS I in view of a decreased quality of life and a large relapse percentage (33%) at long-term follow-up.


Assuntos
Síndromes da Dor Regional Complexa/psicologia , Dor/psicologia , Qualidade de Vida/psicologia , Adolescente , Adulto , Fatores Etários , Síndromes da Dor Regional Complexa/complicações , Feminino , Humanos , Masculino , Dor/etiologia , Medição da Dor , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
3.
J Pediatr Surg ; 43(9): 1640-3, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18778999

RESUMO

PURPOSE: Treatment of blunt injury of the pancreas in children remains controversial. Some prefer nonoperative treatment, whereas others prefer operative management in selected cases. This report reviews the treatment of patients with blunt pancreatic trauma admitted to a level I pediatric trauma center in The Netherlands. METHODS: Medical records of all children less than 15 years with blunt pancreatic trauma admitted to the University Medical Center St Radboud in the period 1975 to 2003 were retrospectively analyzed. RESULTS: Thirty-four children were included, age 3 to 14 years. Most injuries were because of bicycle accidents (58%). On admission, amylase was raised in 90% of the patients. Five patients had pancreatic duct injuries identified by imaging (endoscopic retrograde cholangiopancreaticography was used once, magnetic resonance cholangiopancreaticography twice) or at surgery. Thirty-one children were initially managed nonoperatively. Pancreatic surgery was performed in 3 children (1 Roux-Y, 2 drainage only). Mean hospital stay was 29 days in the operative group and 24 days in the nonoperative group. Fluid collections developed in 2 operated patients. Both resolved spontaneously. In 14 of the 31 nonoperated patients, a pseudocyst developed. Only 6 of these needed secondary intervention. Of these, 3 were drained percutaneously. There was no mortality and no long-term morbidity in both groups. CONCLUSIONS: Nonoperative management of pancreatic injury in children has good clinical outcome. Only 10% need secondary surgery. In 50%, pseudocysts develop of which half can be managed nonoperatively. The reliability of computed tomographic scan grading is of limited value to decide whether to operate primarily. There is little to gain with ERCP and stenting. The place of MRCP as a noninvasive diagnostic tool remains to be determined.


Assuntos
Pâncreas/lesões , Ferimentos não Penetrantes/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos não Penetrantes/cirurgia
4.
Med Mycol ; 46(5): 491-4, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18608916

RESUMO

A case of gastrointestinal zygomycosis in a 10-month-old boy with chronic granulomatous disease (CGD) is presented. Zygomycetes are an uncommon cause of fungal disease in CGD patients and gastrointestinal zygomycosis has not been previously described in individuals with CGD. To improve outcome, a timely and correct diagnosis is of utmost importance.


Assuntos
Gastroenteropatias/microbiologia , Doença Granulomatosa Crônica/complicações , Rhizopus/isolamento & purificação , Zigomicose/diagnóstico , Zigomicose/microbiologia , Humanos , Lactente , Masculino
5.
Acta Paediatr ; 97(7): 875-9, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18410465

RESUMO

BACKGROUND: Complex Regional Pain Syndrome type I (CRPS I) is a potentially incapacitating syndrome which can occur after a minor injury or operation to a limb. It is a disorder characterized by pain, sensory and motor disturbances. CRPS I is well known in adults, but a relatively new diagnostic entity in children. The clinical presentation of CRPS I in children is, to some extent, different from adults and therefore sometimes not recognized early. The aim of this study was to search for differences in patient characteristics between children and adults with CRPS I. METHODS: We have performed a retrospective chart review of 78 children (age

Assuntos
Distrofia Simpática Reflexa/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Temperatura Cutânea
7.
Med Hypotheses ; 69(3): 478-80, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17383111

RESUMO

Embryonic stem cells are undifferentiated pluripotent cells that can indefinitely grow in vitro. They are derived from the inner mass of early embryos. Because of their ability to differentiate into all three embryonic germ layers, and finally into specialized somatic cell types, human embryonic stem cells represent important material for studying developmental biology and cell replacement therapy. They are usually isolated from excess human IVF-embryos. Since many people regard isolation of human stem cells as intentional killing of the embryo, it is a very difficult ethical problem. Similar feelings concern medical or scientific use of these stem cells. Is this feeling correct, or does it arise from a sentimental view? The problem encloses two aspects: (i) use of stem cells for medical therapy and scientific research and (ii) isolation of stem cells from human IVF-embryos. Worldwide human tissues are cultured, transplanted and used for medical and scientific research. Therefore, it may be concluded that factual use of human embryonic stem cells cannot be a real ethical problem. The main key of the problem seems to be hidden in the exact definition of 'death'; in other words: is there nothing between 'death' and 'life'? Bacterial spores, lyophilised bacteria and other micro-organisms, micro-organisms stored in glycerol mixtures at -80 degrees C and tissue cultures and sperm cells stored in liquid nitrogen, they are all neither dead nor alive, but still viable. From this point it is clear that there is more than the antithesis 'dead' versus 'alive'. In addition, we think that there is still another alternative: partial death. The present view concerning isolation of stem cells implies that residual embryos and thus new human lives are killed, and that therefore these embryos must be (passively) destroyed. However, it is especially the very well planned IVF-procedure that makes that passive destruction of not-implanted embryos means intentional killing. By isolation of stem cells embryos are not fully killed: at least one embryonic cell, i.e., a stem cell, remains alive. The life of stem cells cannot be qualified as independent. Nevertheless, the embryo's life is not completely stopped and continues in a primitive way of life and consequently it is not completely dead. Against this background we feel that isolation of human embryonic stem cells is preferred instead of passive destruction.


Assuntos
Pesquisas com Embriões/ética , Células-Tronco Embrionárias/citologia , Fertilização in vitro/métodos , Criação de Embriões para Pesquisa/ética , Bioética , Morte , Fertilização , Humanos , Vida , Transplante de Células-Tronco/métodos
8.
9.
Med Hypotheses ; 67(2): 280-2, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16616992

RESUMO

Short small bowel patients suffer from malabsorption due to a strongly reduced small bowel surface. These patients usually get a high caloric high carbohydrate-low fat diet at oral or enteral feeding. At several points our studies demonstrate that the effect of this formula is doubtful. In these patients the intestinal flora has strongly been changed and even become characteristic due to abundant presence of lactobacilli (up to nearly 100%). In many patients with a high carbohydrate-low fat diet these bacteria both produce massive amounts of d-lactic acid and gaseous CO2, and they destroy the primary bile acids that are necessary for uptake of lipids. Thus, they cause (i) an increased risk of D-lactic acidosis and D-lactic acid-associated encephalopathy, (ii) flatulence, abdominal pain and non-infectious diarrhoea, and (iii) low uptake of fat and lipophilic vitamins. It is argued that by gradually converting the diet to a low carbohydrate-high fat diet growth of the characteristic lactobacilli can be strongly reduced and so also the mentioned inconveniences.


Assuntos
Dieta com Restrição de Carboidratos , Gorduras na Dieta/administração & dosagem , Absorção Intestinal , Síndrome do Intestino Curto/fisiopatologia , Acidose Láctica/etiologia , Acidose Láctica/prevenção & controle , Deficiência de Vitaminas/etiologia , Deficiência de Vitaminas/prevenção & controle , Encefalopatias Metabólicas/etiologia , Encefalopatias Metabólicas/prevenção & controle , Diarreia/etiologia , Diarreia/prevenção & controle , Humanos
10.
Ann Thorac Surg ; 78(3): 1086-8, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15337060

RESUMO

Pericarditis as a complication of appendicitis is a rare event. In a 25-year period we encountered two pediatric cases with this severe complication due to (a)typical presentation of appendicitis resulting in small bowel obstruction, intraabdominal abscesses, constrictive pericarditis, and purulent pericarditis.


Assuntos
Apendicite/complicações , Apendicite/diagnóstico , Pericardite/etiologia , Adolescente , Apendicite/cirurgia , Criança , Erros de Diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva
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