John D. Snyder

Setting Research Priorities to Reduce Global Mortality from Childhood Pneumonia by 2015

Igor Rudan and colleagues report the results of their consensus building exercise that identified health research priorities to help reduce child mortality from pneumonia.

Transjugular intrahepatic portosystemic shunts (TIPS) in children

The transjugular intrahepatic portosystemic shunt procedure is an accepted treatment for adults with complications of portal hypertension. We performed a retrospective review of all pediatric TIPS placements performed at the University of California, San Francisco between 1990 and 1996. Twelve procedures were attempted in nine children, with a mean age (+/- SD) of 9.4 +/- 3.9 years (range, 5 to 15 years) and a mean weight of 31 +/- 18 kg (range, 16 to 70 kg). The indications for TIPS placement were portal hypertension complicated by chronic variceal hemorrhage not controlled with sclerotherapy (n = 7) and hypersplenism with thrombocytopenia (n = 2). TIPS placement was successfully completed initially in seven of nine (78%) patients. Unfavorable vascular anatomy was the cause of failure in two cases. The seven patients who underwent successful TIPS placement were followed up for an average of 136 days (range, 1 to 800 days); two still have patent shunts, three underwent liver transplantation, one had a splenorenal shunt after stenosis, and one died of underlying liver disease. Variceal bleeding was controlled in four of five patients who successfully underwent TIPS placement. Shunt occlusion occurred in four patients; patency was restored by transjugular shunt revision in three, and a splenorenal shunt was performed in one.

Nutrient absorption and weight gain in persistent diarrhea: comparison of a traditional rice-lentil/yogurt/milk diet with soy formula

Summary: We prospectively studied clinical outcome and nutrition absorption in male children (6–36 months of age) with persistent diarrhea (PD) and severe protein-energy malnutrition (mean z score for age, −4.2 × 0.8). Fifty-one children were randomly allocated to receive a combination of khitchri, a rice-lentil mixture, yogurt, and half-strength buffalo milk (group A; n = 26) or full-strength soy formula (group B; n = 25) for 14 days. The initial caloric intake (p < 0.02) and mean weight gain (p < 0.02) were greater in the group B patients. The mean stool volume and frequency were comparable between the two groups. Seven children in group A were considered clinical failures by criteria of weight loss and PD, compared to three in group B. The coefficients of absorption (COA) for protein were similar between the two groups, but group B patients had higher values of COA for energy and fat (p < 0.05) in the second week of nutritional rehabilitation. The majority (63%) of the children improved on the khitchri-yogurt-milk diet but the nutritional outcome was not as good as with the soy formula. These data indicate that a traditional diet can be successfully used in the dietary management of PD and severe malnutrition but that a more optimal composition, yielding a higher success rate, should be sought.

4710 Primary chronic-active gastritis in children: what is the role of h pylori?

Background. H pylori infections are implicated as the cause of nearly all primary (no other known cause) gastritis (PG), especially primary chronicactive gastritis (PCAG). Recent data in adults and children suggest that the association of H pylori and primary gastric and duodenal ulcers may be less than previously reported. To determine whether the association of H pylori and PCAG in children is also lower than initially thought, we reviewed the biopsies of all children undergoing upper GI endoscopy (EGD) at UCSF. Methods. Gastric biopsies obtained from children at UCSF from 1/1/98-8/1/99 were reviewed in a blinded fashion by one GI pathologist. At least 3 specimens from the antrum, fundus, and/or cardia were obtained from each child and were stained with hematoxylin and eosin. Histologic evidence of inflammation was evaluated using the modified Sydney criteria. Specimens demonstrating PCAG but no H. pylori were stained with Giemsa. Patients were excluded from the analysis if they had a known cause for PG. Results. Biopsies from 153 patients (56% male) were evaluated. The mean age was 8.7 (±5.5, std dev) years for all patients, 11.6 (±4.9) years for patients with PCAG and 12.7 (±4.1) years for those with H pylori . The Table shows the rates of PG, PCAG, and H. pylori: All children with H pylori had PCAG but nearly half of the children with PCAG (10/22) had no evidence of H pylori. Significantly more older children (10-20 yrs) had PCAG (p H pylori is a common cause of PCAG but nearly half of the cases of PCAG are idiopathic. These data indicate that the association of H pylori and PCAG is lower than suggested by published reports.