Joel M. Andres

Rifampin relieves pruritus in children with cholestatic liver disease

Chronic cholestatic liver disease in children frequently results in severe intractable pruritus. Current forms of therapy, including cholestyramine, are usually ineffective. Therefore, a 6-wk, double-blind, crossover study was designed to test the ability of rifampin to relieve pruritus in children with chronic cholestasis. Rifampin proved effective in alleviating pruritus in all five children tested compared with a placebo-treated group. After the 6-wk study period, rifampin was continued for 6 mo, and its effectiveness was maintained. No complications resulted from rifampin use. This study and a similar study in older patients with primary biliary cirrhosis suggest that a highly effective form of therapy is available for treatment of severe pruritus in patients with chronic cholestasis. These patients must be carefully selected and frequently monitored.

Lack of efficacy of thickened feeding as treatment for gastroesophageal reflux

The efficacy of thickened feedings for the treatment of gastroesophageal reflux in infancy was evaluated. Fifty-two infants were examined with prolonged pH monitoring of the distal esophagus after feedings of apple juice or apple juice thickened with rice cereal. All infants had a minimum of three feedings of both thickened and unthickened juice. The recordings of distal esophageal pH were analyzed for the percent of time the pH was less than 4 in the first 2 hours after each feeding. The infants were maintained in the following positions after feeding: prone (n = 29), prone-board with the head elevated 30 degrees from horizontal (n = 29), supine (n = 7), and unrestricted (n = 21). We found no significant difference in the percent of time with reflux with thickened versus unthickened feedings except in those infants maintained in the 30-degree prone position. In the first 2 hours after eating thickened juice, infants maintained in this position had increased esophageal reflux time (P less than 0.006). Further analysis revealed that 33% of the infants had a greater than 30% increase in esophageal reflux time after thickened feedings. Our study suggests that the immediate effect of thickened feedings on gastroesophageal reflux in infants is unpredictable.

Hepatocellular carcinoma in 2 young adolescents with chronic hepatitis C.

Hepatitis C virus (HCV) infection is a global health problem affecting 170 million individuals worldwide. In the United States, there are approximately 7 million adults and 100,000 children chronically infected with HCV (1,2). The importance of HCV infection stems from its proclivity to cause insidious liver damage over many years, including chronic hepatitis, cirrhosis, and liver cancer. In adults, HCV infection is a leading cause for liver cancer worldwide (3). The financial burden of this viral infection is staggering, with projected medical costs of

Abnormal gastroduodenal motility in children and adolescents with recurrent functional abdominal pain

10.7 billion in adults from 2010 to 2019 and approximately

Diagnosis and management of colonic polyps in children

426 million during the next 10 years in children (4,5). The epidemiology, clinical outcome, and risk factors associated with progression of HCV-related liver disease are fairly well characterized in adults. Although the natural history of childhood HCV infection is poorly defined, it appears to be an indolent disease in most children (6–13); however, progressive liver disease, including chronic hepatitis and cirrhosis necessitating liver transplantation, can occur in children (14,15). Unlike in adults, liver cancer, particularly hepatocellular carcinoma (HCC), is rare in children (16), but it was described in 2 young adults infected with HCV during childhood (17). Herein we extend these observations and present 2 children with chronic hepatitis C who developed HCC as adolescents. To our knowledge, they are the

Congenital pancreatic hypoplasia: A syndrome of exocrine and endocrine pancreatic insufficiency*

To determine whether motor activity of the stomach and proximal small intestine is a factor in recurrent abdominal pain in adolescents, we prospectively investigated eight patients with recurrent abdominal pain and compared them with seven normal adolescents. All patients underwent a detailed examination to exclude other known organic causes of the pain. The gastroduodenal motor activity during fasting was studied with a semiconductor recording probe. The recordings were analyzed for periodicity, duration, and propagation velocity of the activity front of the migrating motor complex. The amplitude of the antral and duodenal contractions was also determined. The patients with recurrent abdominal pain had more frequent migrating motor complexes, but these were shorter in duration and moved more slowly down the intestine (slower propagation velocities). The patients also had high-pressure duodenal contractions that were associated with abdominal pain during the study period. These studies suggest that altered intestinal motility may be the underlying mechanism of recurrent abdominal pain in some children.

Gastric emptying in infants with gastroesophageal reflux. Measurement with a technetium-99m-labeled semisolid meal.

mon in toddlers and preschoolers, but nearly half of the homes had no syrup of ipecac. Stairways are a common site for falls, and yet over half of homes had ungated accessible stairways. The DCHs operated by younger, less well educated women had a higher level of hazards. These operators would be an appropriate target group for education. The DCHs in apartments or in mobile homes, and those in homes that were rented rather than owned, also had a higher level of hazards. These variables probably reflect family income and, taken with the findings about operator education, suggest that lower socioeconomic status of the DCH operator may place the children cared for at greater environmental risk of injury. The DCHs with younger children and increased numbers of children under care were no safer than other homes, despite the increased risk presented by these factors, How generalizable are these results? Because all these operators had chosen to register with the state and had allowed outsiders to visit their homes, we suspect that our population of DCH operators was a relatively motivated group. This study may therefore underestimate the true level of injury hazards in family DCHs that are not regularly visited by outsiders. Conversely, the study may overestimate the level of family DCH injury hazards in states where regular inspections are mandatory. Do family DCHs have more injury hazards than childrens own homes or than other child care settings? Are children in family DCHs actually injured at higher rates? These important questions need to be addressed in future studies. In light of the present findings, however, we suggest that family DCH operators will require more eduation or increased regulation to decrease injury hazards in home day care. In addition, we suggest that pediatricians advise parents whose children are in DCHs to discuss injury prevention with their DCH operators.

Antibodies to Escherichia coli outer membrane porin C in the absence of anti-Saccharomyces cerevisiae antibodies and anti-neutrophil cytoplasmic antibodies are an unreliable marker of Crohn disease and ulcerative colitis.

We describe two brothers with small size at birth, early-onset insulin-dependent diabetes, and pancreatic exocrine insufficiency. In contrast to the findings in pancreatic aplasia, their serum C-peptide and glucagon levels were measurable. These findings, in concert with their clinical courses, are consistent with the diagnosis of congenital pancreatic hypoplasia.

PERCEPTIONS OF PARENTING STRESS AND FAMILY RELATIONS BY FATHERS OF CHILDREN EVALUATED FOR ORGAN TRANSPLANTATION

AbstractIt is well established that liquid emptying occurs in the absence of motor activity of the stomach. In contrast, solid-phase emptying is controlled in part by antral peristalsis and is, therefore, a more precise indicator of gastric motility. We developed a semisolid, radionuclide gastric emptying test using rice cereal and technetium-99m-sulfur colloid to assess antral physiology in infants with vomiting. Computer-programmed mathematical models were used to determine the shape of a line that best fit our emptying data points. Linear, simple exponential [ f=2−(t/t1/2)], and power exponential