Oral administration of Lactobacillus reuteri during the first year of life reduces caries prevalence in the primary dentition at 9 years of age.

The aim of this study was to evaluate the effect on oral health, at age 9 years, of daily oral supplementation with the probiotic Lactobacillus reuteri, strain ATCC 55730, to mothers during the last month of gestation and to children through the first year of life. The study was a single-blind, placebo-controlled, multicenter trial involving 113 children: 60 in the probiotic and 53 in the placebo group. The subjects underwent clinical and radiographic examination of the primary dentition and carious lesions, plaque and gingivitis were recorded. Saliva and plaque were sampled for determination of mutans streptococci (MS) and lactobacilli (LB) in saliva and plaque as well as salivary secretory IgA (SIgA). Forty-nine (82%) children in the probiotic group and 31 (58%) in the placebo group were caries-free (p < 0.01). The prevalence of approximal caries lesions was lower in the probiotic group (0.67 ± 1.61 vs. 1.53 ± 2.64; p < 0.05) and there were fewer sites with gingivitis compared to the placebo group (p < 0.05). There were no significant differences between the groups with respect to frequency of toothbrushing, plaque and dietary habits, but to intake of fluoride supplements (p < 0.05). There were no intergroup differences with respect to L. reuteri, MS, LB or SIgA in saliva. Within the limitation of this study it seems that daily supplementation with L. reuteri from birth and during the first year of life is associated with reduced caries prevalence and gingivitis score in the primary dentition at 9 years of age.

Endovascular therapy of renovascular hypertension in children: single center analysis.

INTRODUCTION: We present our results after percutaneous transluminal renal angioplasty (PTRA) and stent implantation in the treatment of eight children with renal artery stenosis (RAS) with consequential development of malignant renovascular hypertension (RVH) despite the administration of antihypertensive drugs. PATIENTS AND METHODS: In the period between January 2000 and November 2007, endovascular interventional procedures in the renal arteries were performed in 8 children (six boys and two girls) to treat malignant RVH caused by RAS. The mean patient age+/-standard deviation was 10.8 years+/-3.7 years (median age 9 years; range 8-17 years). Interdisciplinary discussion and evaluation of the indications for endovascular treatment was carried out for all of the eight patients. Our indications for the PTRA procedure were severe RVH with arterial blood pressure (BP) values above the 99th percentile, which did not respond to the administration of antihypertensive drugs. Renal artery stenting was performed due to re-stenosis after PTRA. RESULTS: Diagnostic digital subtraction angiography demonstrated unilateral RAS of the main renal artery in seven children and bilateral stenosis of the renal arteries in one child. We performed 11 endovascular interventions on 9 main renal arteries in 8 children (10 PTRA and one stent placement). In 7 of 8 children, complete correction of RAS was achieved. Follow-up assessment over a mean period of 39 months (range 6-84 months) showed normotension with no antihypertensive treatment in 6 children. One child had a technically successful PTRA and improved BP with reduced requirement for antihypertensive treatment. Technical failure of the endovascular intervention occurred in a boy with severe FMD who underwent successful surgical autotransplantation of the kidney. CONCLUSIONS: Endovascular therapy of RAS in children with consequential development of malignant RVH despite antihypertensive drugs represents the treatment of choice. PTRA and/or stent implantation are technically and clinically feasible and safe in this group of children. Optimal treatment results in children can be expected in a clinical environment with successful interdisciplinary cooperation between the pediatrician, interventional radiologist and pediatric surgeon.