Intestinal organoids in infants and children.

Recent advances in culturing of intestinal stem cells and pluripotent stem cells have led to the development of intestinal organoids. These are self-organizing 3D structures, which recapitulate the characteristics and physiological features of in vivo intestinal epithelium. Intestinal organoids have allowed the development of novel in vitro models to study various gastrointestinal diseases expanding our understanding of the pathophysiology of diseases and leading to the development of innovative therapies. This article aims to summarize the current usage of intestinal organoids as a model of gastrointestinal diseases and the potential applications of intestinal organoids in infants and children. Intestinal organoids allow the study of intestinal epithelium responses to stress factors. Mimicking intestinal injury such as necrotizing enterocolitis, intestinal organoids increases the expression of pro-inflammatory cytokine genes and shows disruption of tight junctions after they are injured by lipopolysaccharide and hypoxia. In cystic fibrosis, intestinal organoids derived from rectal biopsies have provided benefits in genetic studies and development of novel therapeutic gene modulation. Transplantation of intestinal organoids via enema has been shown to rescue damaged colonic epithelium in mice. In addition, tissue-engineered small intestine derived from intestinal organoids have been successfully established providing a potential novel treatment and a new hope for children with short bowel syndrome.

Comparison of Cleaning up Eyelids after Taking off False Eyelashes between Eye Makeup Remover Alone and Eye Makeup Remover with Ocusoft®.

Background: Hirschsprung's disease (HD) is the most common intestinal obstruction in newborn. The Transanal Endorectal Pull -Through (TERPT) is a new surgical procedure that has rapidly replaced traditional ones. Objective: We have reviewed early post-operative complications after TERPT of childhood HD in Thailand. Material and Method: The clinical course and a 1 year outcome of all pediatric HD undergoing TERPT from 5 pediatric surgical centers in Thailand between 2008 and 2011 were reviewed. Results: Seventy-six patients (66 males and 10 females) of HD were included. The average age of diagnosis and surgery are 199 (0-4,015) and 297 (9-4,075) days, respectively, where ages and classification of HD are not related. The associated conditions are Down syndrome (DS) 6.6% and congenital heart disease (CHD) 5.3%. The most common presented symptom was intestinal obstruction. Other symptoms were Hirschsprung, which are associated with enterocolitis (HAEC) 13.1% and intestinal perforation 2.6%. The patients were diagnosed by barium enema (BE) 93.4%, rectal biopsy (RB) 6.6% and anorectal manometry (ARM) 6.6%. HAEC is the most common both pre- and post-operative complications (23.7% and 22.4%). Other post-operative complications are incontinence 13.2%, perianal excoriation 9.2%, anastomosis stricture 7.9%, anastomosis leakage 2.6%, retained aganglionic segment 2.6%, anastomosis volvulus 1.3% and anovaginal fistula 1.3%. One patient died due to anastomosis leakage (1.3%). Five patients were associated with DS, 3 patients (60%) were incontinent, 1 patient had anastomosis stricture (20%) and 2 patients (40%) was HAEC. Conclusion: Most of HD were diagnosed and treated in the newborn period. TERPT is safe and also feasible in all pediatric age groups. The associated DS are related to have more morbidity. HAEC is the most common complication. Even though there are limitations in the diagnostic investigation those did not achieve the standard diagnosis of HD in this study; but the outcomes are not different from the reviews. The improvement in laboratories and pathological investigation services will reflect the surgical service and outcome of pediatric HD in this region. The awareness of post-operative complications will lead to the prevention and early management in the postoperative period.

Bleeding tendency in an adolescent with chronic small bowel obstruction.

We report a case of fat-soluble vitamin deficiency in a 14-year old boy who had chronic duodenal obstruction. He presented with periodic unexplained bleeding tendency. The laboratory results showed positive fat globules in stool and prolonged prothrombin time. His further investigation revealed low plasma vitamin A and undetectable plasma vitamin E. After parenteral vitamin K and oral vitamin A and E supplement, these abnormalities resolved although he still had absent knee jerk. We propose that fat malabsorption and fat-soluble vitamin deficiency can occur after prolonged duodenal obstruction that induce bacterial overgrowth following by bile acid deconjugation. Despite very few case reports, screening for fat malabsorption and fat-soluble vitamin deficiency might be warranted in patients with chronic small bowel obstruction.

Topical steroid is effective for the treatment of phimosis in young children.

BACKGROUND AND OBJECTIVE: The purpose of the present study was to evaluate the effects of non-operative treatment using topical steroids on phimosis in infants and young children. MATERIAL AND METHOD: Between June 2003 and May 2005, the parents of the children with phimosis were instructed to apply and massage the phimotic skin with 0.05% betamethasone valerate cream twice daily for 2 months. During non-operative treatment, the patients whose parents were not satisfied with the results would undergo circumcision. RESULTS: Ninety-two phimotic boys with an average age of 32.62 months (range, 1 to 144 months) were enrolled for steroid application. Of the 92 patients, 79 (85.9%) were satisfied with their results. The other 13 patients whose outcomes clinically improved but did not satisfy their parents finally underwent circumcision. Histologically, circumcised skins of patients initially receiving steroid therapy revealed markedly interstitial edema and slightly increased vasculature. There were no systemic side effects or significant dermal atrophy in the present study. CONCLUSION: Topical steroid treatment for phimosis is successful in young children. This therapeutic approach is a safe, easy, and inexpensive alternative to circumcision.

Primary transanal Swenson pull-through operation for Hirschsprung's disease.

OBJECTIVE: The authors describe an experience with a newly developed technique for the treatment of Hirschsprung's disease (HD)-transanal Swenson pull-through operation (TSPT). METHODS: The records of 27 children (15 males and 12 females) with HD proven on the basis of rectal biopsy or barium enema who underwent primary TSPT between November 2003 and April 2008 were retrospectively reviewed. Rectosigmoidectomy begins at the level just above dentate line in neonates and approximately 1-cm above dentate line in older children. The full-thickness dissection is performed upward around the rectum. The colon is transected above transition zone and anastomosed to the anus. All patients had postoperative pathologic proof. Data are expressed as mean and SD. RESULTS: Mean age at operation was 29.4 +/- 48.2 months (range, 1-155 months). The operative time averaged 153.5 +/- 85.9 min (range, 65-400 min). There was a statistically significant difference between those younger than 1 month (107.1 +/- 14.8 months) and those greater than 1 month (190.7 +/- 101.1 months). None did receive blood transfusion. Average length of hospital stay was 9.1 +/- 4.1 days (range, 4-21 days). Peri- and postoperative complications included anastomotic stricture (n = 6), enterocolitis (n = 3), and urethral injury (n = 1). Fecal continence (stooling frequency rate of 1-2 times per day) was noted in 70.8% (17/24) and 77.8% (14/18) at 1- and 2-year follow-up, respectively. There was no mortality in the series. CONCLUSIONS: Primary TSPT would be an alternative, safe technique in children with HD. The technique is not difficult, and associated with acceptable short-term outcomes. A long-term follow-up will be necessary to assess the real benefit of the technique.