Atakan Comba

Lactose and fructose intolerance in Turkish children with chronic abdominal pain

ObjectiveTo investigate the prevalence of lactose and fructose intolerance in children with chronic abdominal pain.MethodsHydrogen breath tests were done to detect lactose and fructose malabsorption in 86 children with chronic abdominal pain (44 irritable bowel syndrome, 24 functional abdominal pain and 17 functional abdominal pain syndrome as per Rome III criteria) presenting to a Pediatric Gastroentreology department.Results14 (16.3%) of patients were diagnosed with lactose intolerance and 11 (12.8%) with fructose intolerance.ConclusionsLactose and fructose intolerance in children can lead to chronic abdominal pain and symptoms improve with dietary modifications.

Detection of gastroesophageal reflux in children with cerebral palsy using combined multichannel intraluminal impedance–ph procedure

Gastroesophageal reflux (GER) is a very common condition in children with neurological impairment and this can influence nutritional and respiratory outcomes. The aim of this study was to investigate the presence of GER in children with cerebral palsy (CP) using multiple intraluminal impedance (MII)-pH monitoring. The use of combined MII-pH allows for the detection of both acid and non-acid reflux episodes. A total of 29 CP patients with symptoms suggesting GER, aged 2 to 10 years old, underwent 24-hour combined MII-pH monitoring. There were a total of 3899 reflux episodes, of which 29% were acid, 60% were weakly acid and 11% were alkaline. The number of non-acid reflux episodes was statistically significantly greater (p < 0.01). These findings confirm that GER disease is seen frequently in children with cerebral palsy and most of the reflux episodes are not acidic. Non-acid reflux can also influence the morbidity in patients with cerebral palsy. It can be concluded that 70% of the reflux episodes would not have been recognized by pH measurement alone.

A university experience in foreign body aspiration

Atakan Comba, Özlem Yüce, Ahmet Güzel, Mehmet Açıkgöz, Mithat Günaydın, Ayhan Gazi Kalaycı Ondokuz Mayıs Üniversitesi Tıp Fakültesi Çocuk Gastroenteroloji Hepatoloji ve Beslenme Bilim Dalı, Samsun, Türkiye Ondokuz Mayıs Üniversitesi Tıp Fakültesi Çocuk Acil Bilim Dalı, Samsun, Türkiye Ondokuz Mayıs Üniversitesi Tıp Fakültesi Çocuk Cerrahisi ve Ürolojisi Anabilim Dalı, Samsun, Türkiye A University Experience in Foreign Body Aspiration

Akut pankreatit ile başvuran bir duodenal duplikasyon kisti olgusu

Duodenal duplication cyst is a rare congenital anomaly of the gastrointestinal tract. In this article, a 14-year-old male patient with abdominal pain and vomiting is presented. While investigating the etiology of acute pancreatitis, the cystic mass was found in the duodenum. After surgical removal of the cyst, histopathologic examination demonstrated duplication cyst. Duodenal duplication cyst should be remembered as a rare cause of acute pancreatitis.

A rare cause of nephrotic syndrome in a 14-year-old boy: questions.

A previously healthy 14-year-old boy was presented with a 10-day history of progressive periorbital and bilateral lower extremity edema. He also noted that the frequency and amount of his urine had decreased. He had no gross hematuria, no recent sore throat, or upper respiratory tract infections. His medical history was unremarkable, with no known history of kidney disease. Physical examination on admission was unremarkable except for moderate edema on bilateral eyelids and lower extremities. His cardiovascular, respiratory, neurological, and genitourinary exams were all normal. Blood pressure was 130/80 mmHg. His height was 151 cm (25–50 p) andweight was 44.5 kg. Laboratory findings revealed that he had marked hypoalbuminemia (2.1 g/dl) with heavy proteinuria (5167 mg/dl, or 20 mg/mg creatinine) and microscopic hematuria (ten red blood cells/HPFwith no red blood cell casts). Hyperlipidemia (T-Chol 225 mg/dl, TG 263 mg/dl) was also noted. Serum complements were normal (C3 0. 8 g/L, C4 0. 4 g/L), and anti-nuclear antibody was negative. Renal function was intact (creatinine 0.7 mg/dl, BUN 20 mg/dl). HBs antigen, HCVantibody, and human immunodeficiency virus (HIV) were all negative. There was no evidence of streptococcal infection. Based on his clinical and laboratory findings, he was diagnosed as having nephrotic syndrome. The patient was hospitalized and investigated for the etiology of the nephrotic syndrome. During the work-up for a renal biopsy, a cystic mass in the right upper abdomenwas found by ultrasonography and confirmed by computed tomography (CT) scan (Fig. 1).

A rare cause of nephrotic syndrome in a 14-year-old boy: Answers

Detection of a cystic lesion in the liver suggests simple cysts, multiple cysts arising in the setting of polycystic liver disease (PCLD), parasitic or hydatid (echinococcal) cysts, cystic tumors, and abscesses. These conditions can usually be distinguished on the basis of the patient’s symptoms and the radiographic appearance of the lesion [1]. The presence of constitutional symptoms, such as pallor, anorexia, fever or weight loss, may point toward a malignant lesion or infection, but our patient had no medical history or signs of these upon physical examination. Ultrasound of his abdomen revealed a huge liver cyst of 90 mm occupying almost the whole left lobe with mild internal echoes all suggestive of hydatid cyst. The kidneys, spleen and pancreas appeared normal. Abdominal computed tomography (CT) was used to delineate the cystic lesion within the liver. Indeed, the CT confirmed a huge, thick-walled cyst of 90 mm in diameter, occupying the left lobe of the liver in segment I. Hydatid disease (HD), or echinococcosis, is a zoonotic infection caused by the larval stages of the cestodes belonging to the genus Echinococcus. Cystic echinococcosis (CE) is the most common form of HD, and occurs as the result of infection by the larval stages of E. granulosus, which has a worldwide distribution and continues to be a major health problem in developing countries [2–4]. Oncosphere larvae hatch in the duodenum and are carried to the liver through blood vessels or lymphatics. About 65 % are trapped in the liver (first filter), which is the most commonly involved organ (52–77 % of cases); the remaining 25 % are trapped in the lungs (second filter) and less than 10 % reach various organs through the systemic circulation [5]. The symptoms of liver hydatid cysts differ depending on the size and number of cysts, but also on the mass effect within the liver and upon surrounding structures. Patients are usually asymptomatic, but may present with right/epigastric pain, nausea, and vomiting [1]. Considering that the early stages of infection are usually asymptomatic, the diagnosis of hydatid cyst depends on clinical suspicion. Diagnosis is made by history of exposure, by radiological and ultrasound cyst detection, and by serology [6]. The diagnosis of hydatid disease in our patient was confirmed by a strongly positive serum ELISA and indirect hemagglutination test (IHA) for Echinococcus. Treatment This article refers to the article that can be found at http://dx.doi.org/ 10.1007/s00467-012-2282-x.