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1.
Arch Dis Child Educ Pract Ed ; 105(2): 89-93, 2020 04.
Article in English | MEDLINE | ID: mdl-31073038

ABSTRACT

No examination of a child's abdomen or gastrointestinal system is complete without an examination of the 'backside' or perineum, however there is often reluctance among paediatricians to perform this examination routinely. This article aims to describe how to use perineal examination in infants and children. It discusses the indications and stepwise approach to performing a per-rectal examination and interpretation of the findings one could expect to encounter. We include four cases encompassing the major conditions, both congenital and acquired, that paediatricians should be aware of and how they were managed in our institution.


Subject(s)
Pediatrics , Perineum , Physical Examination , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male
2.
J Pediatr Hematol Oncol ; 36(5): 404-6, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24136025

ABSTRACT

A 6-year-old girl presented with presumed relapse of childhood immune thrombocytopenia. Investigations revealed deranged coagulation parameters, abnormal small bowel thickening, and splenomegaly. A clinically significant bleeding diathesis emerged which was refractory to most hemostatic interventions. Laparatomy revealed a composite diagnosis of splenic hemangiomatosis and small bowel lymphangiomatosis. Splenectomy resulted in complete resolution of the coagulopathy. The diagnosis and management of these conditions is inherently complex and without clear guidance. We discuss our perioperative management of the bleeding diathesis. There is a need for long-term follow-up of the underlying pathologies particularly as potentially useful therapeutic agents have emerged.


Subject(s)
Hemangioma/complications , Hemorrhagic Disorders/etiology , Intestine, Small/pathology , Lymphangioma/complications , Splenic Neoplasms/complications , Thrombocytopenia/etiology , Child , Female , Hemangioma/diagnosis , Hemorrhagic Disorders/surgery , Humans , Laparotomy , Lymphangioma/diagnosis , Prognosis , Splenectomy , Splenic Neoplasms/diagnosis , Thrombocytopenia/surgery
3.
Pediatr Diabetes ; 12(4 Pt 1): 322-5, 2011 Jun.
Article in English | MEDLINE | ID: mdl-21615651

ABSTRACT

BACKGROUND: Following the recommendations of The International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2000, our clinic started routine screening of children with type 1 diabetes (T1D) for coeliac disease (CD). OBJECTIVES: To determine the short-term clinical and metabolic effects of gluten free diet (GFD) in a group of children with T1D and confirmed CD. METHODS: Data were collected on all children with T1D and CD between November 2000 and November 2007 before and 12 months after commencement of GFD. Data included the presence of gastrointestinal (GI) symptoms, episodes of severe hypoglycaemia, daily insulin requirements, height, weight, body mass index (BMI), glycosylated haemoglobin (HbA1c), haemoglobin, and persistence of autoantibodies. The effects of GFD on these parameters were studied and compared with those from the revised ISPAD Guidelines in 2007. RESULTS: Four hundred and sixty-eight children with T1D were screened, of whom 23 patients were diagnosed with CD. The mean age at diagnosis of T1D and CD was 6.8 years and 11.1 years, respectively. Ten out of 11 children showed improvement in their GI symptoms, while 6 out of 8 patients had no further severe hypoglycaemic episodes. Nine patients remained positive for antiendomysial antibodies after GFD. There was no significant change in the standard deviation score for height, weight, and BMI or the mean HbA1c and Hb before and after GFD. However the mean insulin requirement increased from 0.88 to 1.1 units/kg/day, which was statistically significant (p < 0.005). CONCLUSION: In our experience, GFD showed short-term benefits by reducing GI symptoms and severe hypoglycaemia while the insulin requirement increased significantly.


Subject(s)
Celiac Disease/complications , Celiac Disease/diet therapy , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Diet, Gluten-Free , Insulin/administration & dosage , Adolescent , Biopsy , Celiac Disease/diagnosis , Celiac Disease/physiopathology , Child , Child, Preschool , Diet, Gluten-Free/adverse effects , Female , Gastrointestinal Tract/physiopathology , Humans , Hypoglycemia/prevention & control , Infant , Intestine, Small/pathology , Longitudinal Studies , Male , Retrospective Studies
4.
Ulster Med J ; 78(1): 10-2, 2009 Jan.
Article in English | MEDLINE | ID: mdl-19252723

ABSTRACT

Small bowel intussusceptions are much less common than the ileocolic type, with jejunoileal intussusceptions being amongst the most rare1. We review the literature on small bowel intussuception, using a case of an 11-year-old girl with a jejunoileal intussusception involving the whole of the small bowel, from the level of the duodenojejunal flexure to the ileocaecal valve, as an illustrative history. The typical CT features of an intussusception and value of CT with regard to identification of complications are highlighted.


Subject(s)
Ileal Diseases/diagnosis , Intussusception/diagnosis , Jejunal Diseases/diagnosis , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Abdomen, Acute/surgery , Child , Female , Humans , Ileal Diseases/pathology , Ileal Diseases/surgery , Intussusception/pathology , Intussusception/surgery , Jejunal Diseases/pathology , Jejunal Diseases/surgery
5.
Pediatr Infect Dis J ; 24(2): 149-52, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15702044

ABSTRACT

BACKGROUND: The exact mode of transmission of Helicobacter pylori is yet to be established. Close personal contact among family members appears to be a key factor. The aim of this study was to establish whether sharing a bed or bedroom with an infected family member is an important risk factor for primary childhood H. pylori infection. METHODS: Fifty-two families with at least 1 child (the index case) with H. pylori infection were recruited. The resultant study population comprised 126 siblings of the index cases. H. pylori infection was established by culture or by histology and urease testing on antral biopsies in index cases and by C-urea breath testing in family members. Data regarding sleeping arrangements within the family were collected. RESULTS: Sharing a bed or bedroom with an infected sibling at the age of 3 years significantly increased the risk of childhood H. pylori infection [odds ratio, 4.84; 95% confidence intervals, 1.54-15.20; P < 0.01 and 3.68 (1.26-10.75), P = 0.017, respectively]. In addition, a child was at significantly increased risk of being infected if his/her mother or father was H. pylori-positive [odds ratio, 2.52; 95% confidence intervals, 1.03-6.13], P = 0.042 and 2.99 (1.04-8.61), P = 0.042, respectively). CONCLUSIONS: Sharing a bed or bedroom with an infected sibling in early childhood increases significantly the risk of childhood H. pylori infection. This provides evidence to support horizontal transmission of H. pylori among siblings.


Subject(s)
Helicobacter Infections/transmission , Helicobacter pylori , Housing , Adult , Beds , Child , Child, Preschool , Cross-Sectional Studies , Disease Transmission, Infectious , Family Health , Female , Humans , Male , Multivariate Analysis , Odds Ratio , Risk Factors , Socioeconomic Factors
6.
Pediatr Emerg Care ; 21(5): 306-8, 2005 May.
Article in English | MEDLINE | ID: mdl-15874812

ABSTRACT

OBJECTIVE: To investigate whether major televised sporting events influence the level of attendance at a pediatric emergency department or reduce subsequent surgical admissions. METHODS: A retrospective analysis of the number of emergency department attendances and subsequent surgical admissions on nights of televised Champions League soccer games, a major pan-European soccer tournament, was made. These figures were compared with paired nights with no live soccer television broadcast. RESULTS: In total, 2560 children and their care providers attended the emergency department between 5 PM on nights of televised Champions League soccer games and 9 AM the next morning (mean 40.0 per night, standard deviation 6.3). Out of these children, only 85 were subsequently admitted to the pediatric surgical department (mean 1.3 per night, standard deviation 1.1). There was no significant difference between these figures and the levels of attendance or admission on paired nights without a live broadcast. CONCLUSIONS: We have demonstrated that the live broadcast of soccer games from a major sporting tournament does not significantly decrease emergency department workload. In addition, it does not reduce the number of children who require admission to a pediatric surgical department. This suggests that the staffing organization of a pediatric emergency department cannot be altered on the basis that a major sporting tournament is being televised.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Pediatrics , Soccer , Surgery Department, Hospital/statistics & numerical data , Television , Child , Humans , Retrospective Studies , Time Factors
7.
J Pediatr Surg ; 44(10): 1938-41, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19853751

ABSTRACT

PURPOSE: The purpose of this study was to investigate if pepsin measured in sputum is a useful marker of pulmonary aspiration secondary to gastroesophageal reflux (GER) in children. It is possible that the induced sputum procedure could cause GER and invalidate the results. The hypothesis stated that healthy children (those without history of respiratory or gastroesophageal symptoms) would not have pepsin detected in induced sputum. METHODS: Children attending surgical outpatients in the Royal Belfast Hospital for Sick Children (Belfast, Northern Ireland) were recruited. After spirometry, sputum was obtained by induction with hypertonic 3% saline. Spirometry was repeated, and complications were noted. An "in-house" enzyme-linked immunosorbent assay was used to measure pepsin concentration in sputum. The lower limit of detection of pepsin was 1.19 ng/mL. RESULTS: Children (n = 21) aged 4 to 16 years were recruited. Twenty children completed the study. No adverse effects were reported. Pepsin was detected in 17 (85%) of 20 sputum samples. CONCLUSIONS: The act of sputum induction appears to induce physiologic GER in a healthy childhood population. The analysis of pepsin in sputum obtained by sputum induction is therefore not useful in the investigation of reflux-related respiratory disease.


Subject(s)
Gastroesophageal Reflux/complications , Pepsin A/analysis , Respiratory Aspiration/diagnosis , Saliva/chemistry , Sputum/chemistry , Adolescent , Age Factors , Biomarkers , Child , Child, Preschool , Enzyme-Linked Immunosorbent Assay , Female , Forced Expiratory Volume/physiology , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/metabolism , Humans , Hydrogen-Ion Concentration , Limit of Detection , Male , Northern Ireland , Respiratory Aspiration/etiology , Respiratory Aspiration/metabolism , Risk Factors , Saline Solution, Hypertonic/administration & dosage , Saline Solution, Hypertonic/pharmacology , Spirometry , Sputum/drug effects , Sputum/enzymology
9.
J Pediatr Surg ; 41(2): 289-93, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16481237

ABSTRACT

OBJECTIVES: Gastro-oesophageal reflux (GOR)-related aspiration is associated with respiratory disease, but the current "gold standard" investigation, the lipid-laden macrophage index (LLMI), is flawed. A specific marker of GOR-related aspiration should originate in the stomach, but not the lung. An assay to detect gastric pepsin in the bronchoalveolar lavage (BAL) of children was developed and validated. METHODS: Gastro-oesophageal reflux was diagnosed in 33 children using intra-oesophageal pH monitoring. Thirteen asymptomatic negative controls requiring endotracheal intubation for elective surgery and 5 positive control patients with observed aspiration were recruited. All subjects received a BAL; the fluid obtained was analysed for the pepsin content and the LLMI. RESULTS: All subjects in the negative control group were negative for pepsin. The positive control group had a significantly greater median pepsin level (P < .01) compared with negative controls. Patients with proximal oesophageal GOR and chronic cough also had significantly elevated pepsin levels (P = .04). The LLMI was not significantly elevated by the presence of cough or GOR. CONCLUSIONS: This study suggests that GOR-related aspiration plays a role in chronic cough in children with known GOR. Detecting pepsin in BAL fluid may therefore become an important adjunct in patient selection for antireflux surgery.


Subject(s)
Bronchoalveolar Lavage Fluid/chemistry , Gastroesophageal Reflux/complications , Pepsin A/analysis , Pneumonia, Aspiration/diagnosis , Pneumonia, Aspiration/etiology , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Immunoassay , Male , Respiration Disorders/diagnosis , Sensitivity and Specificity
10.
J Pediatr Surg ; 41(10): 1683-5, 2006 Oct.
Article in English | MEDLINE | ID: mdl-17011269

ABSTRACT

AIMS: The aim of the study was to evaluate potential benefits in the use of peroperative bowel lavage with Gastrograffin in neonates with gastroschisis. METHODS: A retrospective analysis of newborns with gastroschisis was performed over a 10-year period in 2 centers in the United Kingdom. Two groups were studied wherein one had peroperative bowel lavage with Gastrograffin and the other did not. RESULTS: Data were collected on 116 patients of whom 93 were suitable for analysis. There were no statistically significant differences in primary closure rate, duration of ventilation, parenteral nutrition, or hospital stay. Intestinal obstruction occurred more frequently in the nonlavage group. CONCLUSION: Gastrograffin lavage peroperatively in gastroschisis offers no potential advantage in reducing ventilatory requirements, parenteral nutrition, and hospital stay. It also does not achieve greater primary closure rates, but may reduce the incidence of intestinal obstruction.


Subject(s)
Diatrizoate Meglumine/therapeutic use , Digestive System Surgical Procedures , Gastroschisis/surgery , Intestines , Preoperative Care , Therapeutic Irrigation/standards , Female , Gastroschisis/therapy , Humans , Infant, Newborn , Length of Stay , Male , Parenteral Nutrition , Respiration, Artificial , Retrospective Studies
11.
J Pediatr Surg ; 40(12): 1920-2, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16338319

ABSTRACT

INTRODUCTION: Most patients with recurrent painless rectal bleeding warrant endoscopic examination of the lower gastrointestinal tract. This is often limited to rectum or distal colon. The purpose of this study was to compare the diagnostic yield of limited colorectal endoscopy with total colonoscopy in children with recurrent painless rectal bleeding. METHODS: Retrospective review of 314 patients aged 1 to 15 years who underwent colorectal endoscopy for recurrent rectal bleeding. Two hundred six underwent total colonoscopy, whereas 108 patients had endoscopy limited to the rectum in 22, sigmoid colon in 34, descending colon in 43, and transverse colon in 9. Diagnoses were recorded according to the endoscopic and histological findings. RESULTS: After total colonoscopy, a diagnosis was established in 70% of children compared with 35% of those undergoing limited endoscopy (P < .001). This difference was most noticeable in children with inflammatory bowel disease. Juvenile polyps were diagnosed with similar frequency in both groups, reflecting the rectosigmoid distribution of most polyps. CONCLUSIONS: For children presenting with painless rectal bleeding, a diagnosis can be established in the majority if total colonoscopy is performed. This is particularly true for inflammatory bowel disease. Unless a rectal polyp is suspected, full colonoscopy should be planned.


Subject(s)
Colonoscopy , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/etiology , Adolescent , Child , Child, Preschool , Colon, Sigmoid/pathology , Colonic Polyps/complications , Colonic Polyps/diagnosis , Colonoscopy/adverse effects , Colonoscopy/methods , Diagnosis, Differential , Female , Humans , Infant , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/diagnosis , Male , Rectum/pathology , Recurrence , Sensitivity and Specificity
12.
J Pediatr Surg ; 40(10): 1557-61, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16226984

ABSTRACT

PURPOSE: Fundoplication is frequently required for gastroesophageal reflux (GER)-related respiratory disease. Correlation between esophageal pH data and respiratory symptoms is poor but may be improved by monitoring hypopharyngeal pH. Reflux to the hypopharynx is underestimated by salivary bicarbonate. The aim of this study was to determine if hypopharyngeal pH monitoring using pH 4 and pH 5 as reflux thresholds could predict children with reflux-related respiratory disease. METHODS: One hundred five children aged 4 months to 12 years underwent esophageal and hypopharyngeal pH monitoring. Hypopharyngeal pH data were analyzed using pH 4 and pH 5 as reflux thresholds. pH data from 4 groups were compared: group A, control group, no GER, no respiratory symptoms (n = 20); group B, respiratory symptoms, no GER (n = 16); group C, GER, no respiratory symptoms (n = 26); and group D, both GER and respiratory symptoms (n = 37). RESULTS: Comparing groups C and D, there was no significant difference in hypopharyngeal pH data. Using pH 5 as the reflux threshold, children in group B refluxed to the hypopharynx significantly more frequently than controls. This was most evident in children with wheeze. CONCLUSION: Hypopharyngeal pH monitoring does not differentiate children with GER and respiratory symptoms from those with GER alone and is therefore of doubtful value in diagnosing recurrent aspiration.


Subject(s)
Esophageal pH Monitoring , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/metabolism , Hypopharynx/metabolism , Respiration Disorders/etiology , Respiration Disorders/metabolism , Child , Child, Preschool , Humans , Infant , Severity of Illness Index
13.
J Pediatr Surg ; 40(10): 1547-50, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16226982

ABSTRACT

BACKGROUND: Controversy exists over Helicobacter pylori eradication therapy in the treatment of patients with nonulcer dyspepsia. The lack of pediatric studies has made it difficult to draw conclusions about the use of eradication in dyspeptic children. The aim of this study was to examine long-term symptom severity in pediatric patients with nonulcer dyspepsia and H pylori gastritis after H pylori eradication. METHODS: Thirty-nine children (mean age, 9.0 years) with dyspepsia and H pylori gastritis were prospectively recruited. Severity of symptoms was graded before H pylori eradication. Each patient was followed up at 6, 12, and on average, 61.6 months after eradication, with reassessment of symptoms and H pylori status. RESULTS: There was a significant reduction in the severity of symptoms at 6 and 12 months, and at long-term follow-up compared with the preeradication scores (all P < . 001). At long-term follow-up, reinfection with H pylori was associated with more severe symptoms than if the patients remained free of infection (P = .045). CONCLUSIONS: This study has demonstrated a significant long-term improvement in nonulcer dyspepsia in children after eradication of H pylori. This provides further evidence for the consideration of H pylori eradication in pediatric patients presenting with nonulcer dyspepsia.


Subject(s)
Dyspepsia/complications , Gastritis/complications , Gastritis/microbiology , Helicobacter Infections/complications , Helicobacter Infections/therapy , Helicobacter pylori , Child , Humans , Prospective Studies , Severity of Illness Index
14.
Helicobacter ; 9(4): 285-8, 2004 Aug.
Article in English | MEDLINE | ID: mdl-15270741

ABSTRACT

BACKGROUND: Re-infection with Helicobacter pylori is more common in children than adults, and it is generally accepted that the family unit plays a significant role in primary childhood infection. We investigated whether the family unit plays a significant role in pediatric re-infection and if eradication of H. pylori from the entire family reduces the risk of childhood re-infection. METHODS: Fifty families, each with an H. pylori-infected pediatric index case (mean age 9.48 years), were recruited. A 13carbon urea breath test was performed on all family members in the same house as the index case. Each family unit was randomized into a 'family unit treatment' group (all infected family members treated) or an 'index case treatment' group (index case only treated). RESULTS: At long-term follow-up (mean 62.2 months), there were three re-infected children in the 'index case treatment' group compared with one in the 'family unit treatment' group. The re-infection rate was 2.4% per patient per year in the 'index case treatment' group and 0.7% per patient per year in the 'family unit treatment' group (p = .31). CONCLUSIONS: This study is the first to evaluate the effect of total family unit H. pylori eradication on pediatric re-infection rates and reports the longest period of re-infection follow-up in children. In childhood, re-infection with H. pylori is not significantly reduced by family unit H. pylori eradication.


Subject(s)
Family Health , Helicobacter Infections/drug therapy , Helicobacter Infections/epidemiology , Helicobacter pylori/drug effects , Adolescent , Amoxicillin/therapeutic use , Breath Tests , Child , Child, Preschool , Clarithromycin/therapeutic use , Community-Acquired Infections , Humans , Metronidazole/therapeutic use , Omeprazole/therapeutic use , Organometallic Compounds/therapeutic use , Recurrence , Urea/analysis
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