High- and low-dose oral delayed-release mesalamine in children with mild-to-moderately active ulcerative colitis.

OBJECTIVE: The aim of the study was to assess the safety and efficacy of high- and low-dose oral, delayed-release mesalamine in a randomized, double-blind, active control study of children with mild-to-moderately active ulcerative colitis. METHODS: Patients ages 5 to 17 years, with a Pediatric Ulcerative Colitis Activity Index (PUCAI) score of ≥ 10 to ≤ 55 and a truncated Mayo Score of ≥ 1 for both rectal bleeding and stool frequency, were enrolled. They received body weight-dependent doses of oral, delayed-release mesalamine for 6 weeks in a low- (27-71 mg · g(-1) · day(-1)) or high-dose group (53-118 mg · g(-1) · day(-1)). The primary endpoint was treatment success, defined as the proportion of patients who achieved remission (PUCAI score <10) or partial response (PUCAI score ≥ 10 with a decrease from baseline by ≥ 20 points). Secondary endpoints included truncated Mayo Score and global assessment of change of disease activity. RESULTS: The modified intent-to-treat population included 81 of 83 patients enrolled. Treatment success by PUCAI was achieved by 23 of 41 (56%) and 22 of 40 (55%) patients in the mesalamine low- and high-dose groups, respectively (P = 0.924). Truncated Mayo Score (low-dose 30 [73%] and high-dose 28 [70%] patients) and other efficacy results did not differ between the groups. The type and severity of adverse events were consistent with those reported in previous studies of adults with ulcerative colitis and did not differ between groups. CONCLUSIONS: Both low- and high-dose oral, delayed-release mesalamine doses were equally effective as short-term treatment of mild-to-moderately active ulcerative colitis in children, without a specific benefit or risk to using either dose.

Endoscopic pyloromyotomy for congenital pyloric stenosis.

BACKGROUND: The advent of sophisticated endoscopic devices allows for a variety of procedures heretofore performed surgically. This study describes the results of endoscopic pyloromyotomy for congenital hypertrophic pyloric stenosis (CHPS). METHODS: Ten consecutive infants (7 boys, 3 girls; age range 3-7 weeks), with a diagnosis of CHPS, underwent endoscopic pyloromyotomy while under conscious sedation by using an endoscopic electrosurgical needle knife or a sphincterotome. Incisions were made from the antral to the duodenal side of the pylorus. All procedures except one were performed on an outpatient basis. RESULTS: No complication was encountered in any patient. All patients began regular feedings as soon as they recovered from the effects of the sedative medication and were discharged on the same day. At follow-up (range 6 months to 2 years), all patients were doing well. CONCLUSIONS: Surgery for CHPS has undergone little change in recent decades except for the advent of the laparoscopic approach. Surgical pyloromyotomy is considered simple, inexpensive, and safe. Endoscopic pyloromyotomy is equally simple, probably less expensive, and it can be performed as an outpatient procedure.

Deficiencia de gammaglutamil transpeptidasa en niños con hiperbilirrubinemia directa / Gammaglutamyl transpeptidase deficiency in children with direct hyperbilirrubinemia

Se presentan breves resúmenes clínicos de cinco casos de niños con hiperbilirrubinemia directa en quienes pudo comprobrarse deficiencia de gammaglutamil transpeptidasa, enfatizando en síntomas y signos clínicos - algunos de ellos rebeldes al tratamiento, como ictericia y prurito - y en los datos suministrados por laboratorio y biopsia de hígado; se concluye que como otros autores también lo aseguran, el descubrimiento de bajos niveles de gammaglutamil transpeptidasa en niños con estas características debe estimarse como indicador de mal pronóstico e incluso requerir de manera ocasional de transplante de hígado como aconteció en dos de los casos de la serie estudiada