bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introduction of 6‐Mercaptopurine in Crohn's Disease Patients During the Perioperative Period: A Preliminary Evaluation of Recurrence of Disease
Authors: Kader Howard A. , Raynor Stephen C. , Young Rose , Kaufman Stuart S. , Vanderhoof Jon , Ruby Elizabeth I. , Mack David R. 
Published: February 2024

Background:Recurrence of Crohn's disease after surgery is a common occurrence, pointing to the need for a strategy to prevent recurrent disease. We report the postoperative course of 10 patients who required intestinal resections for complications related to Crohn's disease.Methods:All patients had a Pediatric Crohn's Disease Activity Index score of 10 or greater. Among these patients, 5 began treatment with 6‐mercaptopurine in the perioperative period. All 10 had received various combinations of prednisone and salicylate compounds. Patients who were given 6‐mercaptopurine did not discontinue the medication until 2 years after the surgery.Results:To date, none of the five patients who were placed on 6‐mercaptopurine have had recurrence of their Crohn's disease (mean disease‐free period 32.6 ± 18.4 months). Among those five patients not receiving 6‐mercaptopurine there have been three relapses (mean time to relapse 3.7 ± 1.2 months). Logrank sum analyses of Kaplan‐Meier survival curves show benefit to patients receiving 6‐mercaptopurine in preventing relapses after intestinal resection (p < 0.05).Conclusions:Although the underlying pathophysiologic reasons leading to the high relapse rate after intestinal surgery in Crohn's disease are unknown, we conclude that treatment with 6‐mercaptopurine in the perioperative period may be warranted to help prevent the recurrence of Crohn's disease after surgery.
Transpyloric Enteral Feeding in Critically Ill Children
Authors: Panadero Esther , López‐Herce Jesus , Caro Lourdes , Sanchez Amelia , Cueto Elisa , Bustinza Amaya , Moral Ramon , Carrillo Angel , Sancho Luis 
Published: February 2024

ABSTRACTBackground:Nutrition is important in childhood because the child has a lower energy reserve than the adult and a higher demand for calories because of ongoing growth. In this study, the utility of transpyloric enteral feeding (TEF) in critically ill children was evaluated.Methods:A prospective, descriptive study was made in a pediatric intensive care unit of a tertiary pediatric center of 41 critically ill children, 30 after surgical procedures and 11 with nonsurgical illness, aged 8 days to 12 years, who received transpyloric enteral feeding with 8‐ or 10‐Fr weighted feeding tubes. Analysis was made of tolerance and complications (vomiting, abdominal distension, excessive gastric residual, diarrhea, and pulmonary aspiration) of TEF.Results:The mean duration of TEF was 19.5 ± 26.8 days (range, 1‐120 days). The administration of sedative agents or inotropic drugs did not alter toleration of TEF. Eight of 12 patients treated with continuous infusion of vecuronium tolerated TEF without complications. Eleven gastrointestinal complications occurred in 10 patients, abdominal distension and excessive gastric residual in 7 (17%), and diarrhea in 4 (9.7%). In 7 patients gastrointestinal complications improved, with decreasing use or transitory interruption of TEF, but in 4 patients (9.7%), TEF had to be withdrawn. Gastrointestinal complications were more frequent in postsurgical than in nonsurgical patients (p < 0.001). No patients suffered from pulmonary aspiration, and the incidence of pulmonary infection and hepatic dysfunction diminished during TEF.Conclusions:Transpyloric enteral feeding is a good method of nutritional support in critically ill children and can be used in patients treated with neuromuscular blocking agents. The frequency and severity of complications and the risks of pulmonary infection and hepatic dysfunction related to TEF are low.
Vitamin E Status in Preterm Infants: Assessment by Plasma and Erythrocyte Vitamin E‐Lipid Ratios and Hemolysis Tests
Authors: van Zoeren‐Grobben Diny , Jacobs Nicole J. M. , Houdkamp E. , Lindeman Jan H. N. , Drejer Dik F. , Berger Howard M. 
Published: February 2024

ABSTRACTBackground:Vitamin E is an essential component of the antioxidant defenses, but supplementation can have side effects in the preterm infant. Careful monitoring of vitamin E status is thus essential, however no consensus has been reached on the best clinical method.Methods:In 47 healthy preterm infants, several methods for assessment of vitamin E status were evaluated: plasma and erythrocyte vitamin E levels were measured, vitamin E lipid ratios were calculated, and two variations of the hydrogen peroxide hemolysis test were conducted.Results:At birth, the plasma and erythrocyte vitamin E levels were low. After birth, the plasma levels rose gradually, whereas the erythrocyte levels remained low. In contrast, the vitamin E‐total‐lipid ratio was in the low normal range from birth onwards. Vitamin E‐lipid ratios using two lipid components (cholesterol with triglycerides, or cholesterol with phospholipids) or one lipid component (cholesterol) correlated with the vitamin E‐total‐lipid ratio with a good sensitivity and specificity. The susceptibility of erythrocytes to hydrogen peroxide‐induced damage (measured as potassium release or malondialdehyde production) was high at birth and declined after birth. However, this susceptibility did not correlate with plasma or erythrocyte vitamin E levels or vitamin E‐total‐lipid ratio, and the hydrogen peroxide hemolysis test is not a reliable indicator of vitamin E status in preterm infants.Conclusions:Our study indicated that a gold standard for clinical assessment of vitamin E status in preterm infants is yet to be found.
Copper in Infant Nutrition: Safety of World Health Organization Provisional Guideline Value for Copper Content of Drinking Water
Authors: Olivares Manuel , Pizarro Fernando , Speisky Hernán , Lönnerdal Bo , Uauy Ricardo 
Published: February 2024

ABSTRACTBackground:Copper is an essential nutrient for humans. Recently, a limit of 31.48μmol/l (2 mg/l) was proposed by the World Health Organization as the provisional guideline value for copper content of drinking water. The objective of the study was to determine the tolerance of chronic exposure to drinking water with low or high copper content in infants.Methods:Healthy infants (n = 128) were randomly assigned to receive drinking water with less than 1.57 μmol/l (<0.1 mg/l) (n = 48) or 31.48 μmol/l (2 mg/l) of copper (n = 80) from 3 to 12 months of age. At 6, 9, and 12 months of age, serum concentrations of copper, ceruloplasmin, and superoxide dismutase; erythrocyte metallothionein; bilirubin; transaminases; and γ‐glutamyl transferase were measured.Results:Small differences in biochemical indexes of copper nutrition were observed between the groups, but there was no evidence of adverse or toxic effects. These findings may be explained by an adaptive response to the higher copper intake, limiting copper absorption, and increasing biliary secretion, as well as by an increase in copper storage. It is also possible that the sensitivity of the biochemical indicators employed to detect differences in copper status is limited.Conclusion:No acute or chronic adverse consequences of consuming water with copper content of 31.48 μmol/l (2 mg/l) were detected in infants during the first year of life. The results support the safety of the World Health Organization's provisional guideline value for copper in drinking water during infancy.
Lack of Correlation Between Genotype and Phenotype in Celiac Disease
Authors: Greco Luigi , Percopo Selvaggia , Clot Fabienne , Bouguerra Faouzi , Babron Marie‐Claude , Eliaou Jean‐François , Franzese Carlo , Troncone Riccardo , Clerget‐Darpoux Françoise 
Published: February 2024

ABSTRACTBackground:Celiac disease has a wide range of clinical features. The goal of this study was to evaluate whether specific HLA genotypes are associated with particular clinical appearances.Methods:One hundred forty‐five patients with confirmed celiac disease were oligotyped for DR and DQ HLA genes. Clinical notes, physical examination, and a questionnaire provided their personal data. Patients were grouped into nine genotypic categories, according to the presence of the specific DQ heterodimer DQA1*0501‐DQB1*0201 (hence termed α0β0), in single or double dose, and the presence of the DRB4 antigen.Results:Age at first symptoms and age at beginning of glutenfree diet were not significantly different in the nine groups. The initial symptoms of the disease had a similar distribution in all groups. In twenty‐seven patients, disease was diagnosed by family screening: they shared a similar HLA genotype with those who had relevant symptoms. The actual growth status‐evaluated by standardized height, percentage of median weight for age, and percentage of median weight for height‐was not different in the nine groups. Presence of unusual health complaints was not associated with a specific genotype.Conclusions:There is no evidence that clinical features of celiac disease are associated with different HLA genotypes. Genes outside the HLA may play a relevant role.
Effect of Formula Supplemented with Docosahexaenoic Acid andγ‐Linolenic Acid on Fatty Acid Status and Visual Acuity in Term Infants
Authors: Jørgensen Marianne Hørby , Hølmer Gunhild , Lund Pia , Hernell Olle , Michaelsen Kira Fleischer 
Published: February 2024

ABSTRACTBackground:Docosahexaenoic acid is present in high concentration in retina and does not influence visual development in preterm infants. It is still under discussion whether docosahexaenoic acid is important for visual development in term infants.Methods:Thirty‐seven infants fed formula for a median of 14 days were randomized at median age of 25 days to three formulas: a) DHAGF: 0.3 wt% docosahexaenoic acid and 0.5 wt% γ‐linolenic acid; b) DHAF 0.3 wt% docosahexaenoic acid; or c) STF: standard formula without long‐chain polyunsaturated fatty acids and 17 breast‐fed infants were observed, using blood samples and anthropometric measurements from 1 to 4 months of age. At 4 months, visual acuity was measured by swept steadystate visual evoked potential. A cross‐sectional study on 25 breast‐fed infants was carried out as a reference group for the analyses.Results:Infants fed the two docosahexaenoic acid‐supplemented formula had relative docosahexaenoic acid concentrations in red blood cell phospholipids almost as high as those in breast‐fed infants, whereas infants in the standard formula group had significantly lower levels. The addition of γ‐linolenic acid to the formula had a positive effect on red blood cell arachidonic acid levels, compared with levels obtained using fish oil only. Visual acuity was significantly different among all feeding groups (analysis of variance;p = 0.05, means ± standard deviation: breast‐fed, 0.37± 0.06 logMAR; DHAF and DHAGF combined, 0.40 ± 0.07 logMAR; and standard formula 0.44 ± 0.07 logMAR. However, there was no statistical difference among the formula groups. In a multiple regression analysis including all formula‐fed infants, weight at delivery (p = 0.002), but not type of formula, was significantly associated with visual acuity at 4 months of age.Conclusions:The addition of docosahexaenoic acid resulted in concentrations in red blood cells at similar levels as those in breast‐fed infants, whereas the increase in visual acuity did not reach significance. The addition ofγ‐linolenic acid resulted in higher arachidonic acid concentrations in red blood cells.
Functional Results of Laparoscopic Fundoplication in Children
Authors: Tovar Juan A. , Olivares Pedro , Diaz Mercedes , Pace Rosa A. , Prieto Gerardo , Molina Manuel 
Published: February 2024

ABSTRACTBackground:There is no evidence that the results of laparoscopic fundoplication in children match those of the open procedure. In the current report, pre‐ and postoperative function of the antireflux barrier is examined in children having laparoscopic fundoplication for gastroesophageal reflux.Methods:Twenty‐seven patients with gastroesophageal reflux, aged 7.2 ± 4.5 years, were operated on for unremitting gastrointestinal symptoms (n= 24), with respiratory tract disease (n = 11), cystic fibrosis(n = 2), or brain damage (n = 11). Gastrostomy was added in 5 cases. Barium contrast study, pH‐metering, endoscopic examination, and biopsy were performed before and after a median of 19 months (range, 8 to 46) after operation.Results:At diagnosis, 15 of 21 patients had esophagitis that was moderate or severe in 11 (1 with Barrett's esophagus). Symptoms disappeared after fundoplication in all but 2 patients, in whom they became milder. The reflux index decreased from 20.2 ± 20% to 4.9 ± 9% and became normal in all except 4 children (2 with brain damage and 1 with cystic fibrosis). Open repair of the failed wrap was considered necessary in only 1 of them.Conclusions:Laparoscopic fundoplication is as effective as the open procedure (14% overall failure rate). However, the failure rate in neurologic patients (18%) suggests that before reaching conclusions on the benefits of this approach, careful long‐term assessment of the functional results is necessary.
Hypocaloric Oral Therapy During an Episode of Diarrhea and Vomiting Can Lead to Severe Malnutrition
Authors: Baker Susan S. , Davis Anne M. 
Published: February 2024

ABSTRACTBackground:Malnutrition associated with diarrhea and vomiting can be prevented if the focus of treatment is on nutritional requirements. Some pediatricians inappropriately continue to recommend clear liquids followed by dilute feedings or hypocaloric diets until the diarrhea clears.Methods:Medical records were retrospectively reviewed, and the literature was reviewed.Results:Severe malnutrition occurred in two children with diarrhea and vomiting who were treated with clear liquids followed by restricted nutrient intake.Conclusions:Severe malnutrition associated with diarrhea and vomiting can occur when the prescribed treatment is bowel rest followed by hypocaloric diets until diarrhea clears. Malnutrition can be prevented if the focus of treatment is on nutritional requirements. Current American Academy of Pediatrics recommendations for treatment of diarrhea and vomiting are discussed.
Growth Hormone Resistance and Somatomedins in Children with End‐Stage Liver Disease Awaiting Transplantation
Authors: Greer Ristan M. , Quirk Paul , Cleghorn Geoffrey J. , Shepherd Ross W. 
Published: February 2024

ABSTRACTBackground:The success of orthotopic liver transplantation as treatment for end‐stage liver disease has prompted investigation of strategies to maintain or improve nutrition and growth in children awaiting transplantation, because malnutrition is an adverse prognostic factor. The purpose of this study was to evaluate the effect of recombinant human growth hormone therapy on body composition and indices of liver function in patients awaiting transplant.Methods:The study was designed as a placebo‐controlled, double‐blind, crossover trial. Patients received 0.2 U/kg growth hormone, subcutaneously, or placebo daily for 28 days during two treatment periods, separated by a 2‐week washout period. Ten patients (mean age, 3.06 ± 1.15 years; range, 0.51‐11.65 years, five men), with extrahepatic biliary atresia (n= 8) or two with Alagille's syndrome (n = 2), with end‐stage liver disease, completed the trial while awaiting orthotopic liver transplantation. Height, weight, total body potassium, total body fat, resting energy expenditure, respiratory quotient, hematologic and multiple biochemical profile, number of albumin infusions, insulin‐like growth factor‐1 and 1, growth hormone binding protein (GHBP), and insulin‐like growth factor binding protein‐1 (IGFBP‐1) and insulin‐like growth factor binding protein (IGFBP‐3) were measured at the beginning and end of each treatment period.Results:Growth hormone treatment was associated with a significant decline in serum bilirubin (‐34.6 ± 16.5 µmol/l vs. 18.2 ± 11.59µmol/l; p < 0.02) but there was no significant effect on any anthropometric or body composition measurements, or on any biochemical or hematologic parameters.Conclusions:These children with end‐stage liver disease displayed growth hormone resistance, particularly in relation to the somatomedin axis. Exogenous growth hormone administration may be of limited value in these patients.
Helicobacter pylori Infection May Undergo Spontaneous Eradication in Children: A 2‐Year Follow‐Up Study
Authors: Perri Francesco , Pastore Maria , Clemente Rocco , Festa Virginia , Quitadamo Michele , Niro Grazia , Conoscitore Pasquale , Rutgeerts Paul , Andriulli Angelo 
Published: February 2024

ABSTRACTBackground:Helicobacter pylori infection is generally acquired early in life. However, it is still unknown whether a spontaneous eradication can occur. The purpose of this study was to evaluate whether H. pylori infection can undergo spontaneous eradication in children.Methods:Three hundred and four Italian children (age range, 4.5 to 18.5 years) were tested for H. pylori by means of 13C‐urea breath test. Infected children were followed up every 6 months for as long as 2 years. Parents were instructed to record consumption of antibiotics. At each visit, children underwent a repeat 13C‐urea breath test.Results:Eighty‐five out of 304 (27.9%) children were H. pylori infected. Forty‐eight out of 85 infected children (56.4%) participated in the follow‐up study. After 2 years, 8 (16.6%) infected children had negative results on 13C‐urea breath tests; 2 of them were given antibiotics for concomitant infections. One child was negative at 6 months but became positive again at the next 6‐month 13C‐urea breath test. Forty children remained persistently positive; of them, 10 were treated with a short course of antibiotics.Conclusions:Our findings support the hypothesis that, at least during childhood,H. pylori infection may be a fluctuating disease with spontaneous eradication and possible recurrence.
Further Studies of Anti‐Endomysium and Anti‐Gliadin Antibodies in Patients with Suspected Celiac Disease
Authors: Del Rosario Marian A. , Fitzgerald Joseph F. , Chong Sonny K. , Croffie Joseph M. , Gupta Sandeep K. 
Published: February 2024

ABSTRACTBackground:The finding of characteristic small intestinal mucosal abnormalities on histologic examination of a biopsy specimen remains the first requirement for the diagnosis of celiac disease. A reliable and noninvasive test would be ideal for the patient's convenience and for reducing health‐care costs. The sensitivity and specificity of anti‐gliadin antibodies (AGA‐immunoglobulin[Ig] G, AGA‐IgA) have been variable; anti‐endomysium IgA (EmA‐IgA) is more helpful. In an earlier study conducted at the authors' institution, celiac disease was present in 19 patients examined from 1992 to 1995. Anti‐endomysium titers were higher than normal in all 19 patients (100%). Total villous atrophy was seen in 14 of 17 biopsy specimens (82%) and subtotal atrophy in 3 (18%). The purpose of the current study was to evaluate further the accuracy of EmA‐IgA in diagnosing celiac disease.Methods:One hundred seven patients were screened for celiac disease between March 1996 and July 1997. The level of EmA‐IgA was measured in all patients, and AGA‐IgG and AGA‐IgA were measured in 104 patients. Forty‐six patients underwent endoscopic biopsy of the small bowel, with measurement of disaccharidase enzymes in 45 patients.Results:Five of 46 patients had celiac disease (three boys and two girls; mean age, 5.3 years; 2‐9.5 years); one also had cystic fibrosis and another had insulin‐dependent diabetes mellitus. All five had marked to complete villous atrophy with crypt hyperplasia and increased serum EmA‐IgA(100% sensitivity). None of the remaining patients had increased EmA‐IgA(100% specificity). Serum levels of AGA‐IgG and AGA‐IgA were increased in all four celiac disease patients (100% sensitivity), but they were also high in patients without celiac disease (38% and 92% specificity, respectively), which compromises their diagnostic value. None of the patients confirmed to have celiac disease had IgA deficiency. Abnormal disaccharidase enzyme activities were documented in all five celiac disease patients: severe generalized deficiency (n = 2), moderately severe generalized deficiency (n = 2), and alactasia with moderate deficiency of theα‐glucosidases (n = 1).Conclusions:This study confirmed the reliability and accuracy of EmA‐IgA in the diagnosis of celiac disease. Small bowel biopsy may be unnecessary in EmA‐positive patients in whom celiac disease is suspected.
Faecal Bile Acid and Dietary Residue Excretion in Cystic Fibrosis: Age Group Variations
Authors: Walters Michael P. , Littlewood James M. 
Published: February 2024

ABSTRACTBackground:Earlier studies report the excessive faecal excretions of bile acids and dietary residues in cystic fibrosis (CF). However, few of these investigated large groups of patients using modern pancreatin preparations and little data exists reporting carbohydrate excretion. We therefore aimed to characterise the general levels of malabsorption within age groups of 132 patients attending a regional CF centre.Methods:The faecal excretions of bile acids, fat, nitrogen and carbohydrate were measured. Most of these patients were treated with either (Creon)(n = 58) or Pancrease (n = 51) and prophylactic antibiotics. The patients were grouped in age ranges 0.5 to 5 years, 6 to 10 years, 11 to 15 years and >16 years. Carbohydrate excretion was determined in the 11 to 15 year group.Results:Increased excretions with increment in age group were found which, for bile acids, was twice that of age matched controls. Modest relationships were found between the overall excretion of bile acids and fat, and between the excretion of bile acids and nitrogen. Primary bile acids were a feature of cystic fibrosis stools but the patterns of individual bile acid excretion revealed a trend towards a normal bile acid types with increment in age group. Faecal carbohydrate was significantly increased to levels which may significantly alter large bowel microflora.Conclusions:The data adds to the evidence that maldigestion initiates bile acid sequestration and consequently, the predominance of primary bile acids.
Bisacodyl and High‐Amplitude‐Propagating Colonic Contractions in Children
Authors: Hamid Syed A. , Di Lorenzo Carlo , Reddy S. Narasimha , Flores Alex F. , Hyman Paul E. 
Published: February 2024

ABSTRACTBackground:The purpose of these studies was to determine the suitability of bisacodyl for stimulating high‐amplitude‐propagating contractions in pediatric studies of colonic manometry.Methods:Water‐perfused manometry catheters were inserted into the right colon of children referred for evaluations related to defecation disorders. Colonic motility was measured in a 3‐hour test session: an hour fasting, an hour after a meal, and 30 minutes after administration of a provocative agent.Results:Bisacodyl was superior to edrophonium as a stimulant for inducing high‐amplitude‐propagating contractions. Bisacodyl‐induced high‐amplitude‐propagating contractions were similar in amplitude, duration, propagation velocity, and sites of origin and extinction to naturally occurring high‐amplitude‐propagating contractions. The effect of intrarectal bisacodyl was similar to that of intracecal bisacodyl, except for a delay of 10 minutes in onset. Bisacodyl induced high‐amplitude‐propagating contractions in all 28 children (22 with spontaneous high‐amplitude‐propagating contractions) without evidence of neuromuscular disease and in 2 of 9 children with a colonic neuromuscular disorder and no spontaneous high‐amplitude‐propagating contractions.Conclusions:Bisacodyl‐induced high‐amplitude‐propagating contractions were quantitatively and qualitatively similar to naturally occurring high‐amplitude‐propagating contractions. In selected cases, such as in children receiving total parenteral nutrition or restricted fluid intake, it may be possible to shorten diagnostic colonic manometry using bisacodyl rather than waiting for spontaneous high‐amplitude‐propagating contractions.