Constipation and colonic transit times in children with morbid obesity.

OBJECTIVES: The aim of the study was to determine the frequency of functional constipation according to the Rome III criteria in children with morbid obesity and to evaluate by measuring colonic transit times (CTTs) whether decreased colonic motility is present in these children. PATIENTS AND METHODS: Ninety-one children with morbid obesity ages 8 to 18 years, entering a prospective, randomized controlled study evaluating the effect of an outpatient versus inpatient treatment program of obesity, participated. All of the children filled out a standardized questionnaire regarding their bowel habits, and CTTs were measured using radioopaque markers. Food diaries were also recorded to evaluate their diet. RESULTS: A total of 19 children (21%) had functional constipation according to the Rome III criteria, whereas 1 child had functional nonretentive fecal incontinence. Total CTT exceeded 62 hours in only 10.5% of the children with constipation, and among them, 2 had a total CTT of >100 hours. In the nonconstipated group 8.3% had a delayed CTT. Furthermore, no difference was found between the diet of children with or without constipation, specifically not with respect to fiber and fat intake. CONCLUSIONS: Our study confirms a high frequency of functional constipation in children with obesity, using the Rome III criteria. However, abnormal colonic motility, as measured by CTT, was delayed in only a minority of patients. No relation was found between constipation in these children and fiber or fat intake.

Lifestyle intervention for non-alcoholic fatty liver disease: prospective cohort study of its efficacy and factors related to improvement.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has a high prevalence in obese children. Lifestyle intervention is the primary treatment for NAFLD. However, limited data are available regarding the efficacy of lifestyle interventions. OBJECTIVES: To prospectively determine the efficacy of a lifestyle intervention programme on NAFLD in severely obese children and identify the clinical parameters related to improvement in NAFLD. METHODS: Children admitted to a lifestyle intervention programme were screened for NAFLD. Steatosis was defined as increased echogenicity of the liver on ultrasonography. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were used as surrogate markers for steatohepatitis. The lifestyle intervention programme consisted of physical exercise, dietary counselling and behavioural counselling for a period of 6 months. RESULTS: 144 children were included with a mean age of 14.1 (±2.3) years, BMI z-score of 3.35 (±0.40) kg/m(2). Lifestyle intervention significantly reduced the prevalence of steatosis (31.2-11.9%, p<0.001) and the prevalence of elevated serum ALT (25.7-11.1%, p<0.001) and serum AST (13.3-4.3%, p<0.002). In multivariate regression analysis, improvement in the degree of steatosis and decrease in ALT and AST were all significantly related to improvement in insulin resistance. Improvement in insulin resistance only explained a small part of the observed changes in transaminases. CONCLUSIONS: A lifestyle intervention of 6 months is moderately effective in improving NAFLD in severely obese children. Improvement in insulin resistance is the clinical parameter most strongly associated with improvement in NAFLD. Other factors related to the successful treatment of NAFLD need to be identified so that these can be a focus for new lifestyle and drug interventions.

Fracture of a covered stent used for pseudoaneurysm exclusion in a prosthetic femoro-infrapopliteal bypass.

PURPOSE: To present a case of fracture in a stent-graft used for exclusion of a pseudoaneurysm in a prosthetic femoro-infrapopliteal bypass. CASE REPORT: A Hemobahn stent-graft was inserted into a Dacron femoro-infrapopliteal bypass to avoid repeat surgery for a recurrent distal anastomotic pseudoaneurysm that had been excluded 2 years earlier by a Dacron interposition graft in a 69-year-old woman. Three months after stent-graft implantation, the patient complained of pain around the left knee; plain radiography showed stent fractures at 2 sites coinciding with the proximal and distal anastomoses of the interposition graft, and ultrasonography detected a new pseudoaneurysm at the distal anastomosis. The stent-graft was explanted and the pseudoaneurysm excluded with a new interposition graft. CONCLUSION: Although some stents have high flexibility and radial strength that make them suitable for use in periarticular vessels, interventionists should take into account the possibility of stent fracture when weighing the treatment options.