Man-Shan Kong

Cutoff volume of dietary fiber to ameliorate constipation in children.

OBJECTIVE To evaluate the proper ingested volume of dietary fiber for relieving constipation in children. STUDY DESIGN During a 3-year period, we prospectively evaluated the correlation of intake volume of dietary fiber with improvement of constipation in children. Patients were categorized into younger (3-7 years) and older (8-14 years) children. The evaluation period lasted 12 weeks. A good improvement was defined as the child exhibiting at least 60% relief of the constipation symptoms during the observation period. Freedom from constipation was observed during the last 4 weeks. RESULTS The study population consisted of 422 patients (213 younger, 209 older), with a mean age of 7.89 +/- 4.71 years. Baseline daily dietary fiber intake of the younger and older groups was 5.97 +/- 2.35 g and 9.83 +/- 3.51 g, respectively. 227 cases (53.8 %) showed improvement of constipation, and 49.1 % of the patients had relief of constipation. Greater intake of dietary fiber was positively associated with good improvement of constipation in both groups (P = .002, and P < .001). Cutoff volumes of daily dietary fiber intake in the relief of constipation were 10 g in the younger group and 14.5 g in the older group. CONCLUSION The cutoff of dietary fiber intake needed to relieve constipation increased with age, achievable in a 12-week intervention.

Acute pancreatitis in children

Aim:  To identify clinical, laboratory, and imaging characteristics associated with severe acute pancreatitis in children.

The Impact of Constipation on Growth in Children

The observation on the impact of constipation on nutritional and growth status in healthy children was never reported. During a 4-y period, we evaluated the consequence of constipation on growth in children. The enrolled children were aged between 1 and 15 y with constipation. Medical response of constipation to treatment was evaluated by the scoring of constipation symptoms. The correlation of therapeutic effect of constipation with growth status at 12 wk and 24 wk was statistically evaluated. About 2426 children (1284 boys, 1142 girls) with a mean age of 7.31 ± 3.65 (range 1.1–14.9) y were enrolled. After 12-wk treatment, significant increase of z-scores of height-for-age, weight-for-age, and body mass index-for-age were all found in patients with good medical responses (1377 cases) than in those with poor medical responses (1049 cases). The 1049 patients with poor medical response received advanced medications; significant increase of z-scores of height-for-age, weight-for-age, and body mass index were also found in these patients. A marked increase of appetite was significantly correlated with better gain on height and weight after treatment. We conclude that chronic constipation may retard growth status in children, and a long-term medication for constipation in children appears beneficial to their growth status.

Successful treatment of congenital esophageal web by endoscopic electrocauterization and balloon dilatation.

We report a 3-year-old boy who presented with a foreign body impacted in the esophagus and had a poor tolerance of solid food since he was 5 to 6 months old. In the last 2 years, he developed progressive dysphagia, anorexia, vomiting, and poor weight gain. An esophagoscopy and barium esophagogram revealed an esophageal web in the distal third of the esophagus. Three courses of endoscopic balloon dilatation resulted in transient improvement in his dysphagia and vomiting; a follow-up barium esophagogram and esophagoscopy showed limited improvement of the esophageal stenosis. Two courses of endoscopic electrocauterization and balloon dilatation improved the clinical symptoms and esophageal stenosis.

Usefulness of ultrasonography in acute appendicitis in early childhood

Objective: Acute appendicitis is an uncommon diagnosis in early childhood. It is frequently complicated by delays in diagnosis, perforation, and prolonged hospital stay. The aim of this study was to evaluate the usefulness of ultrasonography (US) in the management of suspected appendicitis in children younger than 3 years of age. Patients and Methods: Seventy-one children under age 3 with acute abdomen and possible acute appendicitis, but with atypical findings, were included. All of the children underwent a US scan to rule out appendicitis. Results: There were 41 positive US results for appendicitis. Three children had false-positive scan results and 2 children had false-negative results. Twenty-eight patients had ruptured appendicitis with tumor formation on US. Eighteen of the 28 patients received emergency appendectomy and the other 10 patients received initial conservative treatment with interval appendectomy. Compared with those who received emergency appendectomy, patients who received initial conservative treatment had a significantly smoother postoperative course, including shorter postoperative hospital stay and earlier postoperative oral intake. The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of abdominal US to diagnose acute appendicitis in cases of atypical findings in early childhood are 95.0%, 90.3%, 92.9%, 92.6%, and 93.3%, respectively. Conclusions: US is a useful and highly accurate tool to assess acute appendicitis in early childhood. US has the potential to aid in diagnosis of early childhood appendicitis to avoid the frequent rupture with tumor formation seen at this age. Initial conservative treatment for ruptured appendicitis with tumor formation is safe and is associated with a smoother postoperative course in early childhood.

Red blood cell scintigraphy in children with acute massive gastrointestinal bleeding

Background: The main topic of the current review is the usefulness of technetium‐99m‐labeled red blood cell scintigraphy (99mTc RBC scan) in children with acute massive gastrointestinal (GI) bleeding.