Unusual Presentation of Cow's Milk Protein Allergy.

Cow's milk protein allergy (CMPA) is an abnormal immunologic response to bovine protein that can result in various gastrointestinal and cutaneous manifestations including diarrhea, failure to thrive, malabsorption, and even protein-losing enteropathy. We describe a case of a 7-month-old breastfed male who presented with severe atopic dermatitis, emesis, oily diarrhea, failure to thrive, electrolyte disturbance, and hemodynamic instability. Following stabilization, additional evaluation revealed concern for abetalipoproteinemia. Ultimately, the patient's symptoms resolved with introduction of an elemental formula and returned with reinitiation of cow's milk protein, confirming the diagnosis of severe CMPA. It is important for the general practitioner to be aware of the various presentations and have a high index of suspicion for CMPA as no symptom or diagnostic test is pathognomonic for diagnosis. Even though it can mimic other causes of malabsorption, a trial with extensively hydrolyzed or elemental formula should be attempted before undertaking invasive testing.

Gastric electrical stimulation: An emerging therapy for children with intractable gastroparesis.

Management of gastroparesis remains challenging, particularly in pediatric patients. Supportive care and pharmacological therapies for symptoms remain the mainstay treatment. Although they are effective for mild and some moderately severe cases, often time they do not work for severe gastroparesis. There are a few prokinetics available, yet the use of these drugs is limited by a lack of persistent efficacy and/or safety concerns. Currently, the only modality for adult patients with severe intractable gastroparesis is surgery, e.g., pyloroplasty and partial gastrectomy, however, this option is generally considered too radical for a growing child. Novel therapeutic approaches, particularly those which are less invasive, are needed. This article explores gastric electrical stimulation (GES), a new therapy for gastroparesis. Unlike others, it neither needs medications nor gastrectomy; rather, it treats through the use of microelectrodes to deliver high-frequency low energy electric stimulation to the pacemaker area of the stomach. Thus, it is tolerated and safe in children. Like in adult patients, GES appears to work in releasing symptoms, improving nutrition, and enhancing the quality of life; it also helps wean off medications and eliminate many needs for hospitalization. Considering the transient nature of gastroparesis in children in many occasions, GES is considered a "bridging" therapy after failed medical interventions and before surgery.

A computerized system to diagnose and treat neonatal apnea using vibrotactile stimulation.

AIM: To develop an appropriate apparatus for monitoring physiological signals and offering noninvasive automated mechanical stimulations for interrupting apneic events in neonates. RATIONALE: Vibrotactile stimulation (VTS) maybe an effective, safer alternative to nursing hand stimulation in treating neonatal apnea. We therefore developed a new diagnostic and therapeutic instrument. METHODS: The main components of the system are a computer running Windows XP using an AMD Athlon TM 64 processor, a neonatal physiological monitor (Model 511; CAS Medical Inc. in Branford, CT), a connector board, cable and data acquisition card (DAQ6602E), an amplifier, external lights, a tacaid vibrotactile stimulator (Audiological Engineering, Somerville, MA and a software application Labview 7.1, National Semiconductor Corporation). The device is a proof of concept at this point and has not undergone testing on neonatal patients. We have tested its ability to identify apneic events and appropriately administering vibrotactile stimulation on a 12-year-old boy with 10 simulated apnea events. RESULTS: Our device functioned 100% in (1) identification of "true apnea," (2) immediate VTS function, (3) accurate monitoring, and (4) safety. CONCLUSIONS: Our evaluation of this system demonstrates that under simulated conditions, pauses in breathing with associated decreased oxygen levels and heart rate are identified. This new medical device has potential to diagnose and treat neonatal apnea effectively and improve the quality of care.