Roberto Gugig

Outcome of acetaminophen overdose in pediatric patients and factors contributing to hepatotoxicity

Seventy-three medical records of pediatric patients admitted for acetaminophen overdose were reviewed. Twenty-eight patients (39%) had severe liver toxic effects, and six of them underwent liver transplantation. Multiple miscalculated overdoses given by parents, with delay in therapy, are risk factors and the major cause of overdose in children 10 years of age or younger.

Early exclusive breastfeeding and maternal attitudes towards infant feeding in a population of new mothers in San Francisco, California.

BACKGROUND Positive parental attitudes towards infant feeding are an important component in child nutritional health. Previous studies have found that participants in the Special Supplemental Women, Infants, and Children (WIC) Program have lower breastfeeding rates and attitudes that do not contribute towards healthy infant feeding in spite of breastfeeding and nutrition education programs targeting WIC participants. The objective of this study was to assess the frequency of exclusive breastfeeding in the early postpartum period and maternal attitudes towards breastfeeding in a population of mothers at two San Francisco hospitals and in relation to WIC participation status. METHODS We interviewed women who had recently delivered a healthy newborn using a structured interview. RESULTS A high percentage (79.8%) of our sample was exclusively breastfeeding at 1-4 days postpartum. We did not find any significant differences in rates of formula or mixed feeding by WIC participant status. Independent risk factors for mixed or formula feeding at 1-3 days postpartum included Asian/Pacific Islander ethnicity (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.17-7.19). Being a college graduate was associated with a decreased risk of formula/mixed feeding (OR 0.28, 95% CI 0.10-0.79). We also found that thinking breastfeeding was physically painful and uncomfortable was independently associated with not breastfeeding (OR 1.41, 95% CI 1.06-1.89). CONCLUSIONS Future studies should be conducted with Asian-Americans and Pacific Islanders to better understand the lower rates of exclusive breastfeeding in this population and should address negative attitudes towards breastfeeding such as the idea that breastfeeding is painful or uncomfortable.

Management of portal hypertension in children

Portal hypertension can be caused by a wide variety of conditions. It frequently presents with bleeding from esophageal varices. The approach to acute variceal hemorrhage in children is a stepwise progression from least invasive to most invasive. Management of acute variceal bleeding is straightforward. But data on primary prophylaxis and long term management prevention of recurrent variceal bleeding in children is scarce, therefore prospective multicenter trials are needed to establish best practices.

Fulminant hepatic failure in children

Fulminant hepatic failure (FHF) in children is a rare but often fatal event. Our knowledge of this disorder is limited by the rarity of the disorder at any single center. Initiatives are underway to accumulate the experience of several large centers in a multicenter study of pediatric FHF in children funded by the NIH (the Pediatric Acute Liver Failure Study Group). Most FHF cases in children remain without a cause. The mechanisms whereby hepatocytes undergo cell death are unknown, as is an understanding of the events leading to FHF and its progression. Therapy has focused on supportive care in an attempt to ameliorate complications, and early referral to a liver transplant center remains crucial. Outcomes are dependent upon the etiology and the degree of CNS involvement. Clinical trials of liver assist devices, hepatocyte transplantation and use of N-acetylcysteine for nonacetaminophen-induced FHF may hold promise for the future.

Self-expandable metal stent placement in a child for treatment of achalasia after failed Heller myotomy

Background and study aims  Childhood achalasia treatment remains inconclusive. What is next after myotomy failure? Repeated pneumatic-dilation put patients at greater risk of perforation with possible symptom recurrence. We report on a 12-year-old patient with a 1-year history of achalasia whom underwent Heller myotomy with fundoplication and recurred with symptoms 1 week after surgery. Pneumatic dilatation was considered but not done because of the risk of esophageal perforation. The decision was made to place a fully covered self-expanding metallic stent (FC-SEMS) for 3 months, which resolved the stenosis as confirmed by esophagram. The patient has remained asymptomatic since the procedure was performed 2 years ago. FC-SEMS is an alternative for treatment of refractory achalasia in children who do not respond to conventional treatment.

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.