Clinical analysis of endoscopic esophageal dilation for the treatment of corrosive esophageal strictures in children / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical application of endoscopic esophageal dilation in the treatment of corrosive esophageal strictures in children.@*METHODS@#A retrospective analysis was performed on the clinical data of 15 children with corrosive esophageal strictures who underwent endoscopic esophageal dilation in Children's Hospital, Zhejiang University School of Medicine. The clinical features, treatment modality of endoscopic esophageal dilation, number of dilations, complications, and prognosis were reviewed.@*RESULTS@#A total of 96 esophageal dilations were performed in the 15 children with corrosive esophageal strictures, with a median of 6 dilations per child. Among them, 9 children (60%) underwent 6 or more dilations. The children with a stricture length of >3 cm had a significantly higher number of dilations than those with a stricture length of ≤3 cm (P<0.05). The children with strictures in a single segment had a significantly better treatment outcome than those with strictures in multiple segments (P=0.005). No complication was observed during all sessions of dilation. The overall effective rate (including significant improvement and improvement) of endoscopic esophageal dilation treatment was 87%, with 2 cases of failure.@*CONCLUSIONS@#Endoscopic esophageal dilation is an effective and relatively safe treatment method for corrosive esophageal strictures in children, and children with strictures in a single segment tend to have a better treatment outcome than those with strictures in multiple segments.

Pancreatitis as the initial manifestation and abdominal lymph node enlargement in a boy / 中国当代儿科杂志

A boy aged 14 years had abdominal pain as the major manifestation, with elevated serum amylase and lipase. Abdominal ultrasound performed early after onset in another hospital showed enlargement of the pancreas and a reduction in echo. Magnetic resonance cholangiopancreatography (MRCP) showed pancreatic duct dilation and an unclear image of the head of the pancreas. Acute pancreatitis was considered. However, his symptoms were not relieved after fasting, fluid infusion, anti-acid therapy, and somatostatin therapy. Then, abdominal CT scan and MRCP found multiple low-density lesions of the pancreas and enlargement of the hilar and retroperitoneal lymph nodes. Exploratory laparotomy found pancreatic edema and multiple hilar nodules with unclear boundaries, and pathological biopsy showed anaplastic large-cell lymphoma. Since the liver, the spleen, bone marrow, and the central nervous system were not involved, he was diagnosed with stage III primary pancreatic lymphoma. After vindesine and dexamethasone were used to reduce tumor load, the patient underwent vindesine-pirarubicin-asparaginase-dexamethasone chemotherapy once and vinorelbine-dexamethasone chemotherapy 8 times. Imaging examination still showed multiple low-density lesions of the pancreas and retroperitoneal lymph node enlargement. His parents discontinued treatment. It is concluded that the rare causes of acute pancreatitis with poor response to conventional treatment should be considered, especially for patients with abdominal lymph node enlargement. Extranodal lymphoma should be considered, and lymph node biopsy should be performed as early as possible to confirm diagnosis. The prognosis of pancreatic lymphoma is associated with clinical stage and pathology.

Clinical features and prognosis of gastrointestinal injury due to foreign bodies in the upper gastrointestinal tract in children: a retrospective analysis of 217 cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical features and prognosis of gastrointestinal injury caused by foreign bodies in the upper gastrointestinal tract in children.</p><p><b>METHODS</b>A retrospective analysis was performed for the clinical data of 217 children who were diagnosed with foreign bodies in the upper gastrointestinal tract complicated by gastrointestinal injury by gastroscopy from January 2011 to December 2016, including clinical features, gastroscopic findings, complications, and prognosis.</p><p><b>RESULTS</b>Among the 217 children, 114 (52.5%) were aged 1-3 years. The most common foreign body was coin (99/217, 45.6%), followed by hard/sharp-edged food (45/217, 20.7%) and metal (35/217, 16.1%). The most common gastrointestinal mucosal injury was ulceration (43.8%), followed by erosion (33.2%). Compared with other foreign bodies, button cells were significantly more likely to cause esophageal perforation (P<0.01). The esophagus was the most commonly injured organ (207/217, 95.4%). Of all the 217 children, 24 (11.1%) experienced infection. The children with perforation caused by foreign bodies had a significantly higher incidence rate of infection than those with ulceration caused by foreign bodies (P=0.003). Of all the 217 children, 204 (94.0%) underwent successful endoscopic removal of foreign bodies. Among these children, 98 were hospitalized due to severe mucosal injury and were given anti-infective therapy, antacids, and supportive care including enteral nutrition through a nasogastric tube and/or parenteral nutrition. Of all the children, 10 left the hospital and were lost to follow-up, and all the other children were improved and discharged.</p><p><b>CONCLUSIONS</b>Most cases of foreign bodies in the upper gastrointestinal tract occur at 1-3 years of age. Coin, hard/sharp-edged food, and metal are the most common foreign bodies. Button cells are more likely to cause esophageal perforation. The incidence rate of secondary infection increases with the increasing severity of gastrointestinal mucosal injury. Children undergoing endoscopic removal of foreign bodies and enteral nutrition through a nasogastric tube tend to have a good prognosis.</p>

Meta-analysis of probiotics preventing allergic diseases in infants / 中华儿科杂志

<p><b>OBJECTIVE</b>To assess the preventive effect of probiotics against pediatric allergic diseases.</p><p><b>METHOD</b>The authors searched all randomized controlled trials on the preventive effect of probiotics on pediatric allergic diseases from 8 databases (Pubmed, Medline, Springer link, highwire, Cochrane, Vip, Wanfang Data and CNKI) up to September 2011. Two reviewers assessed the studies to see if they meet inclusion criteria, and extracted data. Meta-analysis for the result of homogenous studies was made with RevMan 4.2 and the co-effect was pooled by using fixed-effects model of relative risk (RR) ratios.</p><p><b>RESULT</b>Fifteen studies published between April 2001 and September 2011 including 3604 cases were included. All included studies were graded on randomization, allocation concealment, blinding, baseline and loss to follow-up. Meta-analysis based on included studies showed that prenatal and postnatal probiotic supplementation had preventive effect on pediatric atopic eczema by reducing the RR to 0.78 (95%CI: 0.70 - 0.88, P < 0.0001), and 3 studies in which probiotic was given only after birth, the RR was further reduced to 0.75 (95%CI: 0.66 - 0.86, P < 0.0001). Meta analysis for the effect of lactobacilus alone and combined with other bacteria showed that both decreased the RR ratios of 0.57 (95%CI: 0.44 - 0.73, P < 0.0001) and 0.79 (95%CI: 0.64 - 0.97, P = 0.02), respectively.</p><p><b>CONCLUSION</b>Present evidences show that prenatal and postnatal probiotic supplementation will prevent pediatric atopic eczema, but not other allergic diseases such as sensitization, food allergy and asthma.</p>