RESUMEN
The mucosa of the gastrointestinal tract is presumably an important reservoir for human immunodeficiency virus type 1 (HIV-1), but the level of virus-expressing cells within the mucosa of infected patients is not known. To study this issue, we identified HIV-1 mRNA-expressing (positive) mononuclear cells by in situ hybridization in specimens of esophageal mucosa from eight patients with acquired immune deficiency syndrome (AIDS) and esophageal infections. Such cells were not found in four patients with AIDS and no esophageal disease. Immunocytochemical staining revealed that the mononuclear cells expressing HIV-1 mRNA were lamina propria macrophages. The prevalence of positive cells was measured by triplicate determinations in each of three experiments using an inverse sampling technique. No significant differences in prevalence were found among patients or among experiments. The overall prevalence of HIV-1 mRNA-expressing cells in the esophageal lamina propria was 0.059 +/- 0.01%. This prevalence of cells expressing HIV-1 mRNA in the mucosa of patients with mucosal infections may reflect the local abundance of stimuli such as bacterial endotoxin and certain cytokines capable of inducing viral transcription.
Asunto(s)
Esófago/microbiología , VIH-1/genética , ARN Mensajero/análisis , ARN Viral/análisis , Síndrome de Inmunodeficiencia Adquirida/microbiología , Esófago/citología , Humanos , Inmunohistoquímica , Hibridación in Situ , Membrana Mucosa/citología , Membrana Mucosa/microbiologíaRESUMEN
Anthropometric data were collected on 89 children born to human immunodeficiency virus (HIV)-infected women (37 who seroreverted and 52 who were HIV-infected). The main outcomes included birth weight, gestational age, weight, height, arm muscle circumference (AMC), and triceps skinfold thickness (TSF). Gestational age and birth weight were not different between the two groups. The earliest anthropometric evaluation on seroreverted children (age 19 mo) when compared with HIV-infected children (age 21 mo) revealed that weight and weight-for-height percentiles were significantly different (51% vs 33% and 66% vs 48%, respectively). Height and TSF percentiles were not different, although AMC percentiles were lower in infected children (64% vs 43%). In follow-up evaluations, the weight differences between infected and control children did not change. We conclude that HIV does not affect birth weight, but postnatal events result in altered weight gain in HIV-infected children. Lean body mass is lower than in an HIV-negative comparison group at early stages of HIV infection.
Asunto(s)
Composición Corporal , Crecimiento , Infecciones por VIH/congénito , Infecciones por VIH/fisiopatología , VIH-1 , Antropometría , Preescolar , Seropositividad para VIH/fisiopatología , Humanos , Lactante , Recién NacidoRESUMEN
The cellular immune system of the human newborn, like the rest of the immunologic apparatus, is anatomically intact, antigenically inexperienced, and functionally deficient. The latter is suggested by the newborns' enhanced susceptibility to infection, diminished delayed cutaneous hypersensitivity reactions, and selective abnormalities (when compared to adults) of measures of cellular immunity in vitro. These include impaired proliferative response to ubiquitous antigens, depressed lymphotoxin, migration inhibition factor, and immune interferon production, and diminished cytotoxic reactions including cell-mediated lympholysis. By contrast, other aspects of neonatal T cell function, such as to mitogens or allogeneic lymphocytes, natural interferon and leukocyte inhibition factor production, and number and percentage of E-rosette-forming cell are generally normal. These decreased functional properties may provide an explanation for the newborns' susceptibility to infection and for the occasional occurrence of engraftment of foreign cells from either the mother or from prenatal or neonatal blood transfusion.
Asunto(s)
Inmunidad Celular , Recién Nacido , Linfocitos T/inmunología , Citotoxicidad Inmunológica , Humanos , Hipersensibilidad Tardía/inmunología , Síndromes de Inmunodeficiencia/inmunología , Factores Inhibidores de la Migración de Leucocitos/biosíntesis , Activación de Linfocitos , Prueba de Cultivo Mixto de Linfocitos , Linfocinas/biosíntesis , Factores Inhibidores de la Migración de Macrófagos/biosíntesis , Formación de Roseta , Linfocitos T Reguladores/inmunologíaRESUMEN
Monoclonal antibodies to T-cell receptors were used to investigate the prevalence of the two distinct T-cell subpopulations (TCR alpha beta+ and TCR gamma delta+ cells) in the intestinal mucosa of children with celiac disease (gluten-sensitive enteropathy) as compared with normal intestinal mucosa. TCR gamma delta+ cells were rarely identified in the epithelium of human fetal or normal postnatal intestine and few were present in the lamina propria, whereas the number of distribution of TCR alpha beta+ cells closely resembled that of CD3+ cells. Compared with normal intestine, a significant increase in the number of CD3+, CD8+, TCR alpha beta+, and TCR gamma delta+ intraepithelial lymphocytes was present in celiac disease. Although the mucosal TCR gamma delta+ cells were less numerous than TCR alpha beta+ cells in celiac disease, there was a marked increase in the number of TCR gamma delta+ cells as compared with controls. The ligand recognized by the gamma delta T-cell receptor and the function of these cells have not been determined; however, these findings suggest a possible role for TCR gamma delta+ lymphocytes in mucosal immune responses and tissue injury as seen in celiac disease.
Asunto(s)
Enfermedad Celíaca/inmunología , Intestinos/inmunología , Receptores de Antígenos de Linfocitos T/análisis , Linfocitos T/inmunología , Antígenos de Diferenciación de Linfocitos T/análisis , Antígenos CD4/análisis , Antígenos CD8 , Enfermedad Celíaca/patología , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Intestinos/patología , Receptores de Antígenos de Linfocitos T/clasificación , Linfocitos T/patologíaRESUMEN
Mucosal proctectomy and ileoanal pull-through is increasingly used in children requiring total colectomy for ulcerative colitis or familial polyposis. Excellent continence can be achieved with this procedure, and it avoids proctocolectomy and permanent ileostomy. We have evaluated prospectively anorectal function in nine consecutively treated children who underwent ileoanal pull-through. Patients were 8 to 17.5 years of age (median, 11.3 years) at the time of surgery; seven had ulcerative colitis, and two had familial polyposis. Anorectal evaluation was performed before colectomy and ileoanal pull-through, following ileoanal pullthrough, after rectal training, and then at yearly intervals. A biofeedback "rectal training" program was instituted 6 weeks after ileoanal pull-through and a contrast study documenting integrity of the pouch. The program consisted of an initial biofeedback session with the motility unit, followed by daily instillations, through a catheter, of progressively larger volumes of water (from 1 to 6 oz, increasing 1 oz per week) into the ileal pouch. Patients were instructed to retain the water and participate in normal activities after the instillation. This protocol acclimated the patient to sensing distension of the pouch and using the sphincters. The follow-up period ranges from 1 to 4.5 years (median, 2.2 years). All patients are continent by day and night. One patient has nocturnal incontinence with episodes of pouchitis. Stool frequency is three to eight movements per day (median, four), with none at night. Preoperative resting rectal sphincter pressures averaged 74.3 +/- 23.1 mm Hg (mean +/- standard deviation), and a maximum squeeze pressure was 93.9 +/- 25.3 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Proctocolectomía Restauradora , Recto/fisiología , Poliposis Adenomatosa del Colon/fisiopatología , Poliposis Adenomatosa del Colon/cirugía , Adolescente , Canal Anal/fisiología , Biorretroalimentación Psicológica , Niño , Colitis Ulcerosa/fisiopatología , Colitis Ulcerosa/cirugía , Humanos , Presión , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND/PURPOSE: The ileoanal pull-through procedure (IAP) is gaining increasing favor and use in the surgical treatment of children with ulcerative colitis (UC) and familial adenomatous polyposis (FP). Although physiological studies have been performed to assess the outcome of these children, no long-term quality-of-life assessment after the procedure has been performed. METHODS: Forty-three patients were identified who had an IAP at our institution in the last 10 years and were at least 6 months postsurgery. Thirty-four were contacted, and 32 agreed to participate in the survey, which was approved by the Human Studies Committee. Participants completed the standardized Medical Outcome Study Short Form-36 (SF-36), which has well-established normative values. Several supplemental questions were prepared in a similar format dealing with issues specific to the ileoanal pull-through procedure. RESULTS: Of the 32 participants, 19 (59%) were girls and 26 (81%) had ulcerative colitis. Mean age at the time of survey was 18.1 years with 12 less than 18 years and 20 > or =18 years. Data from the latter group could be compared with national normative values for this age. The study group was not statistically different from age-appropriate US population normal values on all assessable scales of physical and mental health in the SF-36 survey including physical functioning, role limitations-physical, bodily pain, general health, vitality, social functioning, role limitations-emotional, and mental health (all P>.05 or mean difference SD units <0.8). The supplemental questionaire demonstrated little adverse effect of the surgery. There was limited consumption of medications to control bowel frequency and little restriction of activity because of the frequency of bowel movements or fear of incontinence. The surgical scar was the sole negative factor of significance. CONCLUSIONS: The ileoanal pull-through procedure is an excellent surgical option for children with ulcerative colitis or familial adenomatous polyposis, and it produced minimal, if any, adverse effects on their long-term quality of life.
Asunto(s)
Poliposis Adenomatosa del Colon/cirugía , Colitis Ulcerosa/cirugía , Proctocolectomía Restauradora , Calidad de Vida , Adolescente , Adulto , Femenino , Indicadores de Salud , Humanos , MasculinoRESUMEN
Although controversial, pancreas divisum has been implicated as a cause of acute pancreatitis when there is stenosis of the accessory papilla that drains the duct of Santorini. Over the past 5 years, four children with pancreas divisum and recurrent pancreatitis were successfully treated surgically. The diagnosis was made by endoscopic retrograde cholangiopancreatography (ERCP) in each case. Surgical treatment included sphincteroplasty to the accessory papilla to improve drainage of the duct of Santorini, opening the ampulla of Vater to expose the ostium of the duct of Wirsung to enlarge it, and cholecystectomy.
Asunto(s)
Ampolla Hepatopancreática/cirugía , Páncreas/anomalías , Pancreatitis/etiología , Enfermedad Aguda , Adolescente , Niño , Preescolar , Femenino , Humanos , Páncreas/cirugía , Conductos Pancreáticos/anomalías , Esfinterotomía TransduodenalRESUMEN
We report a case of esophageal adenocarcinoma 20 years after esophageal atresia repair. From one case report it is premature to recommend cancer surveillance for all esophageal atresia patients. However, the first survivors are now reaching an age when esophageal cancer related to chronic esophagitis may become more prevalent.
Asunto(s)
Adenocarcinoma/cirugía , Atresia Esofágica/cirugía , Neoplasias Esofágicas/cirugía , Complicaciones Posoperatorias/cirugía , Adenocarcinoma/etiología , Adenocarcinoma/patología , Adulto , Atresia Esofágica/patología , Neoplasias Esofágicas/etiología , Neoplasias Esofágicas/patología , Esofagitis/complicaciones , Femenino , Humanos , Complicaciones Posoperatorias/patología , Factores de TiempoRESUMEN
A wide range of clinical syndromes exist that are related to adverse reactions to dietary proteins and that affect predominantly the gastrointestinal tract of infants and children. Experimental data suggest a critical role for developmental alterations affecting intestinal permeability and the mucosal immune response that predispose to these conditions. The diagnostic and therapeutic approach to these disorders varies depending on the nature of the presumed offending antigen, the anatomic site affected, the severity of the inflammatory process, and the implications for future dietary and medical management. Ultimately, the proof that a particular dietary antigen is responsible is dependent on observing the response to oral challenge.
Asunto(s)
Hipersensibilidad a los Alimentos/complicaciones , Enfermedades Gastrointestinales/etiología , Niño , Enfermedades del Esófago/etiología , Hipersensibilidad a los Alimentos/diagnóstico , Humanos , Lactante , Enfermedades Intestinales/etiología , Enfermedades de la Boca/etiología , Gastropatías/etiologíaAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/microbiología , Cardiomiopatías/microbiología , VIH-1/aislamiento & purificación , Corazón/microbiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/congénito , Autorradiografía , Cardiomiopatías/complicaciones , Cardiomiopatías/fisiopatología , ADN Viral/análisis , VIH-1/genética , Humanos , Lactante , Hibridación de Ácido Nucleico , ARN Viral/análisisAsunto(s)
Eritema Nudoso/terapia , Enfermedades Inflamatorias del Intestino/complicaciones , Piodermia Gangrenosa/terapia , Estomatitis Aftosa/terapia , Eritema Nudoso/etiología , Humanos , Enfermedades Inflamatorias del Intestino/terapia , Piodermia Gangrenosa/etiología , Estomatitis Aftosa/etiologíaAsunto(s)
Enfermedad de Crohn/terapia , Interleucinas/uso terapéutico , Adulto , Animales , Anticuerpos Monoclonales/uso terapéutico , Niño , Ensayos Clínicos como Asunto , Colitis Ulcerosa/terapia , Citocinas/antagonistas & inhibidores , Citocinas/uso terapéutico , Modelos Animales de Enfermedad , Humanos , Lactante , Activación de LinfocitosAsunto(s)
Intestino Delgado/inmunología , Animales , Desarrollo Embrionario y Fetal , Humanos , Mucosa Intestinal/embriología , Mucosa Intestinal/inmunología , Mucosa Intestinal/trasplante , Intestino Delgado/embriología , Intestino Delgado/trasplante , Linfocitos/citología , Ratones , Ratones Desnudos , Modelos Biológicos , Trasplante HeterólogoAsunto(s)
Pruebas Respiratorias , Síndromes de Malabsorción/diagnóstico , Gases , Humanos , Hidrógeno , Lactante , Recién Nacido , Intestinos/fisiología , LactosaRESUMEN
Children with HIV disease and gastrointestinal disease should be evaluated for enteric pathogens. Bacterial, protozoal, and viral agents can cause chronic diarrhea, abdominal pain, gastrointestinal bleeding, and contribute to growth retardation. This article presents an approach to the evaluation of the HIV-infected child with gastrointestinal symptoms. Therapeutic and nutritional interventions are discussed with emphasis on the multidisciplinary approach required to initiate successful management.