Immunoglobulin A Vasculitis With Intussusception in Children.

BACKGROUND: Immunoglobulin A (IgA) vasculitis with intussusception is acute and severe vasculitis combined with acute abdomen in children. The diagnosis of the disease depends on the results of imaging examinations, and its treatment mainly includes enema and surgery. The literature summarized the detailed diagnosis and treatment data in previous literature reports. METHODS: We described the clinical manifestations, ultrasonic features, and treatment of patients admitted to a single center and reviewed previous literature regarding cases with detailed clinical data in the PubMed database within the past 20 years. RESULTS: The review included 36 patients, including 22 boys and 14 girls. A total of 32 patients were diagnosed using ultrasound (88.9%). The main sites of intussusception were the ileum and ileocolon in 16 (44.4%) and 11 (30.6%) cases, respectively. Thirteen patients (36.1%) were treated with enema, with 6 responding to the treatment. 26 patients (72.2%) underwent surgical treatment. Patients with ileal intussusception were more likely to be treated with surgery than those with colonic intussusception (P < .05). The single-center clinical data of 23 patients showed that there was no significant difference in laboratory test findings between patients with and without surgical treatment (P > .05). Patients with long insertion lengths were more likely to require surgery and resection (P < .05). CONCLUSIONS: Ultrasonography is the first-line investigation for diagnosis. The main sites of intussusception were ileum and ileocolon. The length of intubation was related to surgery; treatment is according to the intussusception site. Air enema is not suitable for intussusception of the small intestine.

Modified Sipjeondaebo-tang (JAROTANG) for Henoch-Schonlein purpura nephritis (HSPN): Two case reports.

INTRODUCTION: Henoch-Schönlein purpura (HSP) is a disease commonly manifesting purpura, joint pain, and gastrointestinal symptoms. It can lead to glomerulonephritis (Henoch-Schönlein purpura nephritis, HSPN), which is directly associated with mortality and progression to chronic kidney disease (CKD). While HSP occurs more commonly in children, deadly outcomes occur at a higher rate in adult patients. Previous studies have not reported effective treatment of HSPN by Western or traditional medicine. Here, we report two cases of adult HSPN patients treated with the herbal medicine Jarotang (JRT, modified Sipjeondaebo-tang, modified SJDBT). CASE SUMMARY: Two female patients (Cases 1 and 2), who were 26 and 27 years old, respectively, came to visit us complaining mainly of cutaneous purpura. Both women were diagnosed with HSP, and the results of urinalysis indicated that the HSP had already progressed to renal involvement (3+ proteinuria with 3+ urine occult blood in case 1; 100-120 RBC/HPF with 2+ urine occult blood in Case 2). Both patients were given modified SJDBT in the name of JRT, with some herbs added to disperse and circulate stagnant qi, relieve indigestion, and clear heat. After treatment, patient 1 showed only a trace level of urine occult blood, with disappearance of purpura and proteinuria. Patient 2 showed complete remission of purpura and hematuria. CONCLUSIONS: Modified SJDBT, namely, JRT was effective in treating 2 cases of adulthood HSP and subsequent nephritis. This may be due to the ability of this therapy to replenish qi and blood and/or its immunological effect on T cells. The medication can serve as an effective cure for HSPN.

Clinical analysis of 99 children with Henoch-Schönlein purpura complicated with overt gastrointestinal bleeding.

OBJECTIVE: To analyze and summarize the clinical features, diagnosis, and treatment of children with Henoch-Schönlein purpura (HSP) complicated by overt gastrointestinal bleeding (GI bleeding) for achieving early identification, prevention, and treatment in terms of severe GI bleeding. METHODS: A retrospective analysis was conducted on children with HSP complicated by overt GI bleeding who were admitted to the Department of Traditional Chinese Medicine of Beijing Children's Hospital from January 2017 to December 2019. According to the severity of GI bleeding, the patients were divided into mild bleeding group (61 cases) and moderate and severe bleeding group (38 cases). Inflammatory parameters, coagulation function, GI ultrasound findings, and clinical features were compared. Logistic regression analysis was used to determine the related variables affecting the severity of GI bleeding, and the ROC curve was used to determine the variable test efficacy. RESULTS: Onset in summer, wide distribution of skin rash with facial involvement, the elevation of D-dimer and high neutrophil-to-lymphocyte ratio (NLR) had significant effects on the severity of GI bleeding. ROC curve analysis showed that the optimal cut-off points of NLR and D-dimer for predicting severe GI bleeding in children with HSP were 10.56 and 0.89 mg/L, respectively. CONCLUSION: Facial rash may be a warning sign of GI bleeding. Enhanced monitoring of NLR and D-dimer is helpful for early recognition of GI bleeding as well as assessment of severity.

Efficacy and safety of Xijiao Dihuang decoction in treating Henoch-Schönlein purpura: Study protocol for systematic review.

BACKGROUND: Henoch-Schönlein purpura is one of the most common systemic vascular inflflammatory disease in childhood with purpuric rash, arthritis, renal involvement, and abdominal pain. As a treatment for it, Xijiao Dihuang decoction, a traditional herbal formula, has been used. The object of this systematic review and meta-analysis is to assess the effificacy and safety on Xijiao Dihuang decoction in treating allergic purpura. METHODS: The following electronic databases will be systematically searched up to November 7, 2019 for eligible studies: The Cochrane Library, Embase, PubMed, Web of Science, the Chinese National Knowledge Infrastructure (CNKI), the Chinese Biomedical LiteratureDatabase (CBM), the Chinese Scientifific Journal Database (VIP), andtheWanfang Database. Thetreatment group in the included studies will receive both routine western medicines and Xijiao Dihuang decoction, while the control group will receive routine western medicines. Data extraction and risk of bias assessments will be conducted by 2 independent reviewers. Heterogeneity will be assessed by I2 statistics, while reporting bias will be evaluated by funnel plots and Begg and Egger test. Sensitivity analysis and Subgroup analysis will be performed when necessary. Review Manager software (RevManV.5.3.0) and Stata will be used for all statistical analyses. Ethics approval is not required as no privacy data were involved. This systematic review and meta analysis will be published in a peer-reviewed journal. RESULTS: This study could provide a systematically evaluated therapeutic efficacy and safety of XJDHD on patients with HSP via including RCTs that matches the needs. And we also expect to find predictors of treatment through subgroup analysis, helping patients with HSP detect as well as cope with the disease as early as possible. CONCLUSION: The conclusion of our study will provide the systematical review of the efficacy and safety of XJDHD on patients with HSP, and provide predictors of treatment. PROSPERO REGISTRATION NUMBER: PROSPERO CRD 42018111293.

Myocarditis and intracardiac thrombus due to Henoch-Schönlein purpura: case report and literature review.

Cardiac involvement is very rare in patients with Henoch-Schönlein purpura (HSP). In this case study, we present an 8-year-old girl presenting with HSP-induced myocarditis and thrombus in the right atrium and HSP nephritis. To date, 15 cases of HSP-related cardiac involvement have been reported in the PubMed/MEDLINE, Scopus, and Google Scholar databases. These cases, together with our case, are included in this review. We excluded those patients with other rheumatologic diseases (acute rheumatic fever, acute post-streptococcal glomerulonephritis, Kawasaki disease) accompanied by HSP. Three were children and 13 were adults and all were male except our case. This review revealed tachyarrhythmia, chest pain, dyspnea, murmur, and heart failure as the major signs. Cardiac tests, electrocardiogram (ECG), and imaging methods (echocardiography in all patients, cardiac magnetic resonance imaging (MRI) in three, cardiac biopsy in one, and post-mortem necropsy in three) showed that the cardiac involvements were pericardial effusion, intra-atrial thrombus, myocarditis, coronary artery changes, myocardial ischemia, infarction and necrosis, subendocardial hemorrhage, and left ventricular dilatation. Kidney involvement was not observed in three patients. As the treatment, high-dose prednisolone and cyclophosphamide, oral corticosteroid, azathioprine, nadroparin calcium, ACE inhibitors, calcium antagonists, beta-blockers, and diuretics were used. Eleven patients (all three children and eight of the adults) had a complete cardiac recovery. Cardiac involvement in adults was more likely to be fatal. Death (three patients), ischemia, and infarct have been reported only in adults. We suggested that early and aggressive treatment can be life-saving. MRI examination is effective at identifying cardiac involvement.

Cord-derived mesenchymal stem cells therapy for liver cirrhosis in children with refractory Henoch-Schonlein purpura: A case report.

RATIONALE: To explore the curative effect of human umbilical cord-derived mesenchymal stem cell (ucMSC) therapy for patients with liver cirrhosis complicated with immune thrombocytopenia and refractory Henoch-Schonlein purpura (HSP). PATIENT CONCERNS: A 12-year-old boy presented to our hospital with an 11-month history of purpura on the skin of both lower limbs accompanied by thrombocytopenia. The patient had a history of repeated swelling and painful dorsum pedis, followed by skin redness. DIAGNOSIS: Bone marrow slides showed megakaryocyte maturation disorder. Based on the pathology and drug abuse history, he was diagnosed with nodular cirrhosis, secondary allergic purpura, and thrombocytopenia, etiologies related to his drugs and an immune dysfunction. INTERVENTIONS: ucMSC transplantation was performed, the liver damaging drugs were discontinued, and the appropriate liver immunosuppressive drugs were administered. ucMSCs were injected 8 times/wk in 2 months, with a median cell count of 5.65 × 10/L, ranging from 5.48 to 5.98 × 10/L. OUTCOMES: As the patient's skin rash resolved, his platelets gradually increased to >150 × 10/L and liver transaminase levels gradually decreased to a normal level. Ultrasonography of the abdomen indicated that the round nodules in the liver decreased in size and that the spleen thickness also decreased. LESSONS: This is a unique case of significant HSP with associated thrombocytopenia in a patient with liver cirrhosis. Long-term oral administration of excessive herbal medicine may cause liver damage. We believe that ucMSCs provide a novel approach for the treatment of liver cirrhosis.

Chinese herbal medicine for the treatment of Henoch-Schönlein purpura nephritis in children: A prospective cohort study protocol.

INTRODUCTION: Henoch-Schönlein purpura nephritis (HSPN) involves the renal impairment of Henoch-Schönlein purpura and can easily relapse into life-threatening late nephropathy in severe cases. Although there is a lack of validated evidence for its effectiveness, Chinese herbal medicine (CHM) is one of the most commonly used methods in China to treat HSPN. It is thus need to report the protocol of a prospective cohort trial using CHM to investigate the effectiveness, safety and advantages for children with HSPN. METHODS AND ANALYSIS: This large, prospective, multicenter cohort study started in May 2015 in Shenyang. Six hundred children diagnosed with HSPN were recruited from 3 institutions and are followed-up every 2 to 4 weeks till May 2020. Detailed information of participants includes general information, history of treatment, physical examination, and symptoms of TCM is taken face-to-face at baseline. ETHICS AND DISSEMINATION: This study has received ethical approval from the ethics committee of institutional review board of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine (No.2016CS(KT)-002-01). Articles summarizing the primary results and ancillary analyses will be published in peer-reviewed journals. TRIAL REGISTRATION: Clinical Trials Registration: NCT02878018.

[Association of serum vitamin D level with severity and treatment in children with Henoch-Schönlein purpura].

OBJECTIVE: To investigate the association of serum vitamin D [25-(OH)D3] level with the severity and treatment in children with Henoch-Schönlein purpura (HSP). METHODS: A total of 50 children with newly-diagnosed HSP between January and December, 2015 were enrolled as HSP group, and 49 healthy children were enrolled as control group. Fasting serum samples were collected, and ELISA was used to measure serum 25-(OH)D3 level. According to the serum 25-(OH)D3 level, the HSP group were further divided into normal group (>20 ng/mL) (n=9), insufficiency group (15-20 ng/mL) (n=15), deficiency group (≤15 ng/mL) (n=25), and severe deficiency group (≤5 ng/mL) (n=1). The general data, clinical manifestations, hormone therapy, course of disease before admission, and length of hospital stay were compared between groups. RESULTS: The HSP group had a significantly lower serum 25-(OH)D3 level than the control group (16±6 ng/mL vs 29±5 ng/mL; P<0.01). Compared with the normal and insufficiency groups, the deficiency and severe deficiency groups had significant increases in the incidence rate of renal involvement, rate of hormone application, and median length of hospital stay (P<0.05), while there was no significant difference in course of disease before admission (P>0.05). CONCLUSIONS: Children with HSP have a low serum 25-(OH)D3 level, and such children may have a high risk of renal involvement, a high rate of hormone application, and a prolonged length of hospital stay. However, further studies are needed to investigate whether vitamin D supplementation is helpful to the treatment of HSP and can shorten the course of disease in children with HSP.

Hemorragia pulmonar, una complicación poco frecuente en una niña con púrpura de Schonlein-Henoch / Pulmonary hemorrhage, a rare complication in a girl with Henoch-Schonlein purpura

La púrpura de Schonlein-Henoch (PSH) es la vasculitis más frecuente en los niños. Los procesos vasculíticos pueden afectar el pulmón. Si bien la hemorragia alveolar difusa puede considerarse una de las manifestaciones de la PSH, no es un cuadro frecuente. En este artículo presentamos el caso de una niña de 10 años con nefritis por PSH que sufrió hemorragia pulmonar. La paciente recibió un tratamiento satisfactorio con metilprednisolona intravenosa. La revisión de las publicaciones reveló que la edad temprana puede influir de manera positiva en el pronóstico, y que los inmunosupresores y el tratamiento complementario son fundamentales.

Henoch-Schonlein purpura (HSP) is the most common vasculitis in children. Vasculitic processes can involve the lung. Although diffuse alveolar hemorrhage may be seen as one of the manifestation of HSP, it is not a frequent presentation. Here we reported the case of a 10-year-old girl with HSP nephritis who developed pulmonary hemorrhage. The patient was treated successfully with intravenous methylprednisolone. A review of the literature revealed that young age may be a good prognostic sign and that immunosuppressive drugs and supportive management are essential in the treatment.

Pulmonary hemorrhage, a rare complication in a girl with Henoch-Schönlein purpura / Hemorragia pulmonar, una complicación poco frecuente en una niña con púrpura de Schönlein-Henoch

Henoch-Schonlein purpura (HSP) is the most common vasculitis in children. Vasculitic processes can involve the lung. Although diffuse alveolar hemorrhage may be seen as one of the manifestation of HSP, it is not a frequent presentation. Here we reported the case of a 10-year-old girl with HSP nephritis who developed pulmonary hemorrhage. The patient was treated successfully with intravenous methylprednisolone. A review of the literature revealed that young age may be a good prognostic sign and that immunosuppressive drugs and supportive management are essential in the treatment.

La púrpura de Schonlein-Henoch (PSH) es la vasculitis más frecuente en los niños. Los procesos vasculíticos pueden afectar el pulmón. Si bien la hemorragia alveolar difusa puede considerarse una de las manifestaciones de la PSH, no es un cuadro frecuente. En este artículo presentamos el caso de una niña de 10 años con nefritis por PSH que sufrió hemorragia pulmonar. La paciente recibió un tratamiento satisfactorio con metilprednisolona intravenosa. La revisión de las publicaciones reveló que la edad temprana puede influir de manera positiva en el pronóstico, y que los inmunosupresores y el tratamiento complementario son fundamentales.

[Clinical research on effectiveness of 2 110 patients with Henoch Schonlein purpura from 19 comprehensive hospitals in real world].

Nineteen comprehensive hospital information system (HIS) data are collected. Cleaning up the database, then analysis the patients' information. Using the basic description method and association rules to analysis the data. Analysis the data come from HIS database, we found that in 2 110 patients, main five complications are Henoch Schonlein purpura nephritis, upper respiratory tract infections, renal insufficiency, virus infection and glomerulonephritis (chronic), treatment of chemical drugs with sugar cortical hormone and anti infection drugs, such as intravenous input cephalosporin drugs. Traditional Chinese medicine with blood-activating and stasis-resolving medicine, heat clearing and detoxifying medicine. Combination scheme with blood-activating and stasis-resolving medicine joint glucocorticoid, followed by blood-activating and stasis-resolving medicine combined antiallergic drugs, heat-clearing and detoxifying medicine combined antiallergic drugs. Promoting blood circulation and removing blood stasis is an important part of traditional Chinese medicine treatment in patients with Henoch Schonlein purpura.

Recurrent intussusception.

Recurrent intussusception is defined as an occurrence of intussusception of a bowel loop in a patient with a prior resolution of intussusception, either spontaneously or with an intervention. It is not rare to develop a subsequent episode after a successful reduction of intussusception. We report the cases of 2 children who presented to the emergency department with recurrent intussusception and review the pertinent literature.

Chinese herbal medicine Danshen formulations for preventing renal disease in Henoch-Schönlein Purpura: a systematic review and meta-analysis.

OBJECTIVES: The study objective was to evaluate the use of Danshen formulations in preventing renal disease in Henoch-Schönlein Purpura (HSP) either as sole agents or in combination with other drug regimens. METHODS: Search strategy--Databases searched were the Cochrane Central Register of Controlled Trials, PubMed, Embase (Excerpta Medica Database), the Chinese Biomedicine Database, CNKI (Chinese National Knowledge Infrastructure), and VIP-database for all relevant studies without any language restriction. The cut-off date for the search was October 2010. Selection criteria--All randomized controlled trials with enrolled patients of all ages without renal disease before random assignment were included. The primary outcomes were the number of patients who developed renal disease and the incidence of adverse effects of drugs. Data collection and analysis--For dichotomous outcomes, the incidence of renal disease in patients with HSP was calculated as a relative risk with 95% confidence intervals. For continuous outcomes, the weighted mean difference with 95% confidence intervals was used. RESULTS: A total of five trials (513 children aged 2-14 years old) were included in the meta-analyses, which indicated that Danshen formulations (injections or tablets) with symptomatic therapy significantly reduced the risk of developing renal disease in children with HSP compared to symptomatic therapy alone 6-12 months after treatment (relative risk: 0.35, 95% confidence interval: 0.20-0.61). Adverse effects of Danshen formulations were not explicitly reported in these studies. CONCLUSIONS: Danshen formulations may help prevent renal disease in children with HSP without serious side-effects. However, the evidence is of low quality (as assessed using the GRADE approach), and thus there is insufficient proof to strongly recommend the use of Danshen formulations in children with HSP. Large, properly randomized, placebo-controlled, double-blind studies are needed to substantiate its use.

Henoch-Schönlein purpura with intussusception: a case report.

Gastrointestinal symptoms in Henoch-Schönlein purpura (HSP) are common and occur in about two-thirds of HSP patients. Surgical intervention is only required in a minority of cases. Intussusception is a rare complication and the most common surgical indication for HSP. We report a 3-year-old boy with HSP and clinical manifestations of palpable skin rash Lasting for 4 days, fever for 3 days, intermittent abdominal cramping pain, and left ankle arthralgia Lasting for several hours. Abdominal sonography revealed characteristic signs of intussusception including a doughnut sign and a pseudo-kidney sign in the right upper quadrant of the abdomen. After unsuccessful initial reduction by air enema, surgical reduction was arranged and manual reduction of the ileocecal intussusception without bowel resection was carried out.

Henoch-Schönlein purpura in childhood: treatment and prognosis. Analysis of 425 cases over a 5-year period.

The objective of this study was to identify the most effective treatment by evaluating the different therapies used to treat mild, moderate, and severe Henoch-Schönlein purpura (HSP) patients. We performed a retrospective study of children discharged with a diagnosis of HSP. The study group consisted of 425 children divided into mild, moderate, and severe condition groups. Different therapeutic protocols of hydrocortisone sodium succinate (HCSS) therapy, methylprednisolone (MP) pulse therapy, and MP combination with tripterygium glycoside (TG) therapy were used to treat the different groups. The evaluation of curative effect was performed. After 4 weeks, all patients with no obvious recovery were treated by strengthening the different treatment intervention. The remission time of skin, joint, and gastrointestinal manifestations was evaluated, and the results of the follow-up were analyzed (remission time of proteinuria, relapse, and side effects of therapy). After 4 weeks, in the mild group, the difference of the curative effect between HCSS and MP therapy was not statistically significant. Moderate HSP patients were more likely to respond to MP therapy than HCSS therapy (P < 0.05). Severe HSP patients were more likely to respond to MP combination with TG than single MP therapy (P < 0.05). At last follow-up, they all had normal urinalysis. In the moderate HSP group, the mean duration of proteinuria was shorter in the MP pulse therapy group than in the HCSS therapy group (P < 0.05). In the mild group, the mean duration of purpura was shorter in HCSS therapy group than in the MP pulse therapy group (P < 0.05). At last follow-up, 99 patients had recurrences of purpura and/or proteinuria and 41 patients had liver functional impairment and/or hypertension. The relapse and side effects were all satisfactorily controlled, and the rates of relapse and side effects did not differ between groups with different therapies (P > 0.05). Our study has demonstrated a superior effect for HCSS therapy in patients with mild HSP disease, for MP therapy in patients with moderate disease, and for MP combined with TG therapy in patients with severe disease. MP therapy administered initially reduces the duration of urinary protein abnormality. The therapeutic protocols did not increase the risk of relapse and were safe.

[Preventive effect of integrative medical therapy on children Henoch-Schonleln purpura with renal impairment].

OBJECTIVE: To observe the clinical effect of integrative medicinal therapy in treating children Henoch-Schonlein purpura (HSP) and its preventive effect on complicated renal impairment. METHODS: One hundred and twenty children with HSP were equally randomized into two groups, the treated group and the control group. Both were treated with conventional Western medical therapy, but Sanhuang Qingxue Yin (SQY, a Chinese herbal drug) was given additionally to the treated group. Besides, a group consisted of 30 healthy children was set up as a normal control. Changes of symptoms, physical signs, routine urine, plasma endothelin-1 (ET-1) and urinary levels of beta2-microglobulin (beta2-MG), albumin (ALB) and immunoglobulin G (IgG) before and after treatment were observed, and the recurrence was monitored. RESULTS: The cure rate and the total effective rate in the treated group were 80.0% and 98.3%, while those in the control group were 61.7% and 88.3%, showing significant differences between groups (P < 0.05); the disappearance time of clinical symptoms was shorter in the treated group than in the control group, also showing a significant difference (P < 0.01); after 1-month treatment, levels of plasma ET-1, and urinary beta2-MG, ALB and IgG were improved in the treated group, reaching the levels opproximate to those in the normal control (P > 0.05), significant difference was shown as compared with those in the control group and with those before treatment respectively (P < 0.01, P < 0.05). The recurrent rate was 13.33% in the treated group and 30.0% in the control group, and they were statistically different (P < 0.05). CONCLUSION: The integrative medicinal therapy is good for treating HSP in children, it could not only obviously relieve clinical symptoms, shorten the illness course and reduce the recurrent rate, but also effectively prevent the occurrence of renal impairment.

[Clinical observation on treatment of anaphylactic purpura nephritis by traditional Chinese herbs and Western medicine].

OBJECTIVE: To compare the clinical efficacy of Chinese traditional herbs (CTH) alone or combined with Western medicine (conventional treatment plus different doses of prednisone) in treating anaphylactic purpura nephritis (APN). METHODS: Clinical data of 232 patients with APN were collected and analyzed. They were assigned to four groups. Patients in Group A1 were treated with CTH; in Group A2 were treated initially with Western medicine but turned midway to CTH; in Group B1 and B2 treated with CTH combined with conventional Western medicine and plus low or high dose of prednisone respectively. The comprehensive clinical efficacy on symptoms, physical signs, routine urine examination, blood creatinine and urea nitrogen, as well as the treatment duration and long-term effect in the four groups were observed. RESULTS: There was no significant difference in the comprehensive clinical effects among the four groups (P > 0.05). However, the treatment duration was significantly shorter in Group A1 and B1 than in the other two groups (P < 0.01). Follow-up study on patients in similar duration showed similar reoccurrence rate among groups (P > 0.05). CONCLUSION: Chinese herbs has definite effects on APN with the treatment course shorter than that of other treatments, the optimal protocol for treatment of APN is applying Chinese herbs alone or combined with conventional Western medicine plus low dose prednisone. It is necessary to conduct a follow-up study even though the patients have been cured.

[Invagination in children: not always ileocaecal]. / Invaginaties bij kinderen: niet altijd ileocoecaal.

Three patients, two girls aged 10 and a boy aged 11, suffered from secondary intussusception. Two of the cases were mistakenly managed as an idiopathic or classic intussusception. Hydrostatic reduction with a contrast enema was thought to be successful when retrograde influx in the ileum was seen. As the intussusception recurred, a diagnostic laparoscopy was performed followed by laparotomy and surgical treatment. In both cases an ileo-ileal intussusception was found. In one case the lead point was a malignant lymphoma, in the other case probably an area of vasculitis associated with Henoch Schönlein purpura. The enema had only repositioned the ileocolic part of the intussusception. In the third patient, the ileo-ileal intussusception resolved spontaneously. Due to the location of the intus-susception, a lead point was suspected and a laparoscopy was performed. A Meckel's diverticulum was found and resected. The importance of looking for a lead point is emphasized when dealing with an intussusception in children over the age of 3, or with evidence of underlying disease. In such cases, the relative value of a contrast enema for diagnosis and reposition is emphasised. There should be a low threshold for further investigation, including diagnostic laparoscopy.

Therapy for children with henoch-schonlein purpura nephritis: a systematic review.

Although severe kidney involvement in children with Henoch-Shonlein purpura (HSP) is rarer than that in adults, morbidity should not be underevaluated and follow-up is mandatory. Some drugs are introduced as well-defined treatment options, others can be promising therapeutic alternatives. Therapy of HSP nephritis in children can range from simply steroids to combined immunosuppressant treatments. The prophylactic treatment for renal complication of patients with HSP has been sometimes suggested, but with conflicting results and ultimately not clearly proven. The treatment of overt HSP nephritis includes steroids and other immunosuppressant drugs. Methylprednisolone pulse therapy and prednisone per os are tested drugs. These steroids could be used in combination with other immunosuppressant drugs, such as cyclosporin A and cyclophosphamide. Unfortunately, of these two drugs, only cyclophosphamide is demonstrated as effective in a recent randomized controlled trial. However, since there are insufficient data and unstructured study designs, ACE-I, azathioprine, mycophenolate mofetil, and urokinase need to be more tested in childhood HSP nephritis. In addition to drugs, other techniques are used to treat the severe form of nephritis. Of these, in a multicenter study, plasmapheresis demonstrated efficacy in delaying the progression of kidney disease. However, no convincing studies have been made to date concerning either intravenous immunoglobulin, factor XIII administration, antioxidant vitamin E, and fish oil to treat HSP nephritis.