RESUMO
Bone mass in childhood is highly influenced by puberty. At the same age, bone mass was higher for pubertal than pre-pubertal children. A high level of tracking during 7 years from childhood through puberty was shown, indicating that early levels of bone mass may be important for later bone health. INTRODUCTION: Bone mass development in childhood varies by sex and age, but also by pubertal stage. The objectives of this study were to (1) describe bone mass development in childhood as it relates to pubertal onset and to (2) determine the degree of tracking from childhood to adolescence. METHODS: A longitudinal study with 7 years of follow-up was initiated in 2008 to include 831 children (407 boys) aged 8 to 17 years. Participants underwent whole body dual-energy X-ray absorptiometry (DXA) scanning, blood collection to quantify luteinizing hormone levels, and Tanner stage self-assessment three times during the 7-year follow-up. Total body less head bone mineral content, areal bone mineral density, and bone area were used to describe development in bone accrual and to examine tracking over 7 years. RESULTS: Bone mass in pubertal children is higher than that of pre-pubertal children at the same age. Analysing tracking with quintiles of bone mass Z-scores in 2008 and 2015 showed that more than 80% of participants remained in the same or neighbouring quintile over the study period. Tracking was confirmed by correlation coefficients between Z-scores at baseline and 7-year follow-up (range, 0.80-0.84). CONCLUSIONS: Bone mass is highly influenced by pubertal onset, and pubertal stage should be considered when examining children's bone health. Because bone mass indices track from childhood into puberty, children with low bone mass may be at risk of developing osteoporosis later in life.
Assuntos
Envelhecimento/fisiologia , Densidade Óssea/fisiologia , Desenvolvimento Ósseo/fisiologia , Puberdade/fisiologia , Absorciometria de Fóton/métodos , Adolescente , Antropometria/métodos , Criança , Feminino , Seguimentos , Humanos , MasculinoRESUMO
OBJECTIVES: This European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position statement provides a comprehensive guide for health care providers to manage percutaneous endoscopic gastrostomy tubes in a safe, effective, and appropriate way. METHODS: Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of evidence, recommendations reflect the expert opinion of the authors. Final consensus was obtained by multiple e-mail exchange and during 3 face-to-face meetings of the gastroenterology committee of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. RESULTS: Endoscopically placed gastrostomy devices are essential in the management of children with feeding and nutritional problems. The article focuses on practical issues such as indications and contraindications. CONCLUSIONS: The decision to place an endoscopic gastrostomy has to be made by an appropriate multidisciplinary team, which then provides active follow-up and care for the child and the device.
Assuntos
Fenômenos Fisiológicos da Nutrição do Adolescente , Fenômenos Fisiológicos da Nutrição Infantil , Nutrição Enteral , Medicina Baseada em Evidências , Gastrostomia/reabilitação , Adolescente , Criança , Europa (Continente) , Gastrostomia/efeitos adversos , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Comunicação Interdisciplinar , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Sociedades CientíficasRESUMO
OBJECTIVES: Eosinophilic esophagitis (EoE) represents a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. With few exceptions, 15 eosinophils per high-power field (peak value) in ≥1 biopsy specimens are considered a minimum threshold for a diagnosis of EoE. The disease is restricted to the esophagus, and other causes of esophageal eosinophilia should be excluded, specifically proton pump inhibitor-responsive esophageal eosinophilia. This position paper aims at providing practical guidelines for the management of children and adolescents with EoE. METHODS: Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of an evidence base, recommendations reflect the expert opinion of the authors. Final consensus was obtained during 3 face-to-face meetings of the Gastroenterology Committee and 1 teleconference. RESULTS: The cornerstone of treatment is an elimination diet (targeted or empiric elimination diet, amino acid-based formula) and/or swallowed, topical corticosteroids. Systemic corticosteroids are reserved for severe symptoms requiring rapid relief or where other treatments have failed. Esophageal dilatation is an option in children with EoE who have esophageal stenosis unresponsive to drug therapy. Maintenance treatment may be required in case of frequent relapse, although an optimal regimen still needs to be determined. CONCLUSIONS: EoE is a chronic, relapsing inflammatory disease with largely unquantified long-term consequences. Investigations and treatment are tailored to the individual and must not create more morbidity for the patient and family than the disease itself. Better maintenance treatment as well as biomarkers for assessing treatment response and predicting long-term complications is urgently needed.
Assuntos
Esofagite Eosinofílica/terapia , Eosinófilos , Esôfago/patologia , Corticosteroides/uso terapêutico , Criança , Consenso , Esofagite Eosinofílica/complicações , Esofagite Eosinofílica/dietoterapia , Esofagite Eosinofílica/tratamento farmacológico , Estenose Esofágica/etiologia , Estenose Esofágica/terapia , Humanos , RecidivaRESUMO
OBJECTIVE: Primary gastrointestinal neuropathies are a heterogeneous group of enteric nervous system (ENS) disorders that continue to cause difficulties in diagnosis and histological interpretation. Recently, an international working group published guidelines for histological techniques and reporting, along with a classification of gastrointestinal neuromuscular pathology. The aim of this article was to review and summarize the key issues for pediatric gastroenterologists on the diagnostic workup of congenital ENS disorders. In addition, we provide further commentary on the continuing controversies in the field. RESULTS: Although the diagnostic criteria for Hirschsprung disease are well established, those for other forms of dysganglionosis remain ill-defined. Appropriate tissue sampling, handling, and expert interpretation are crucial to maximize diagnostic accuracy and reduce interobserver variability. The absence of validated age-related normal values for neuronal density, along with the lack of correlation between clinical and histological findings, result in significant diagnostic uncertainties while diagnosing quantitative aberrations such as hypoganglionosis or ultrashort Hirschsprung disease. Intestinal neuronal dysplasia remains a histological description of unclear significance. CONCLUSIONS: The evaluation of cellular quantitative or qualitative abnormalities of the ENS for clinical diagnosis remains complex. Such analysis should be carried out in laboratories that have the necessary expertise and access to their own validated reference values.
Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Anormalidades do Sistema Digestório/diagnóstico , Sistema Nervoso Entérico/fisiopatologia , Gastroenteropatias/diagnóstico , Trato Gastrointestinal/inervação , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Doenças do Sistema Nervoso Autônomo/congênito , Doenças do Sistema Nervoso Autônomo/patologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Criança , Consenso , Anormalidades do Sistema Digestório/patologia , Anormalidades do Sistema Digestório/fisiopatologia , Neoplasias do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/patologia , Neoplasias do Sistema Digestório/fisiopatologia , Sistema Nervoso Entérico/anormalidades , Sistema Nervoso Entérico/patologia , Ganglioneuroma/diagnóstico , Ganglioneuroma/patologia , Ganglioneuroma/fisiopatologia , Gastroenterologia/métodos , Gastroenteropatias/congênito , Gastroenteropatias/patologia , Gastroenteropatias/fisiopatologia , Trato Gastrointestinal/anormalidades , Trato Gastrointestinal/patologia , Trato Gastrointestinal/fisiopatologia , Humanos , Lactente , Pseudo-Obstrução Intestinal/diagnóstico , Pseudo-Obstrução Intestinal/patologia , Pseudo-Obstrução Intestinal/fisiopatologia , Neoplasia Endócrina Múltipla Tipo 2b/diagnóstico , Neoplasia Endócrina Múltipla Tipo 2b/patologia , Neoplasia Endócrina Múltipla Tipo 2b/fisiopatologia , Pediatria/métodosRESUMO
BACKGROUND AND OBJECTIVES: A revision of criteria for diagnosing coeliac disease (CD) is being conducted by The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). In parallel, we have performed a survey aimed to evaluate present practices for CD among paediatric gastroenterologists and to learn their views on the need for modification of present criteria for CD diagnosis. PATIENTS AND METHODS: Questionnaires were distributed to experienced paediatric gastroenterologists (ESPGHAN members) via the Internet. RESULTS: Overall, 95 valid questionnaires were available for analysis, pertaining to 28 different countries, with the majority of responders treating patients with CD for >15 years. Only about 12% of the responders comply with present criteria, noncompliance being related mainly to the challenge policy. Approximately 90% request a revision and modification of the present criteria. Forty-four percent want to omit the small bowel biopsy in symptomatic children with positive anti-tissue transglutaminase immunoglobulin (Ig) A or endomysial IgA antibodies, especially if they are DQ2/DQ8 positive. For silent cases detected by screening with convincingly positive anti-tissue transglutaminase IgA or EMA IgA, about 30% consider that no small bowel biopsy should be required in selected cases. Adding human leukocyte antigen typing in the diagnostic workup was asked for by 42% of the responders. As for gluten challenge, a new policy is advocated restricting its obligation to cases whenever the diagnosis is doubtful or unclear. CONCLUSIONS: Based on these opinions, revision of the ESPGHAN criteria for diagnosing CD is urgently needed.
Assuntos
Doença Celíaca/diagnóstico , Fidelidade a Diretrizes , Guias como Assunto , Padrões de Prática Médica , Adolescente , Adulto , Biópsia , Doença Celíaca/imunologia , Criança , Pré-Escolar , Glutens/imunologia , Pesquisas sobre Atenção à Saúde , Humanos , Imunoglobulina A/análise , Intestino Delgado , Sociedades Médicas , Inquéritos e Questionários , Transglutaminases/imunologia , Adulto JovemRESUMO
OBJECTIVE: Diagnostic criteria for coeliac disease (CD) from the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) were published in 1990. Since then, the autoantigen in CD, tissue transglutaminase, has been identified; the perception of CD has changed from that of a rather uncommon enteropathy to a common multiorgan disease strongly dependent on the haplotypes human leukocyte antigen (HLA)-DQ2 and HLA-DQ8; and CD-specific antibody tests have improved. METHODS: A panel of 17 experts defined CD and developed new diagnostic criteria based on the Delphi process. Two groups of patients were defined with different diagnostic approaches to diagnose CD: children with symptoms suggestive of CD (group 1) and asymptomatic children at increased risk for CD (group 2). The 2004 National Institutes of Health/Agency for Healthcare Research and Quality report and a systematic literature search on antibody tests for CD in paediatric patients covering the years 2004 to 2009 was the basis for the evidence-based recommendations on CD-specific antibody testing. RESULTS: In group 1, the diagnosis of CD is based on symptoms, positive serology, and histology that is consistent with CD. If immunoglobulin A anti-tissue transglutaminase type 2 antibody titers are high (>10 times the upper limit of normal), then the option is to diagnose CD without duodenal biopsies by applying a strict protocol with further laboratory tests. In group 2, the diagnosis of CD is based on positive serology and histology. HLA-DQ2 and HLA-DQ8 testing is valuable because CD is unlikely if both haplotypes are negative. CONCLUSIONS: The aim of the new guidelines was to achieve a high diagnostic accuracy and to reduce the burden for patients and their families. The performance of these guidelines in clinical practice should be evaluated prospectively.
Assuntos
Doença Celíaca/diagnóstico , Duodeno/patologia , Antígenos HLA-DQ/sangue , Imunoglobulina A/sangue , Transglutaminases/imunologia , Adolescente , Doença Celíaca/imunologia , Doença Celíaca/patologia , Criança , HumanosRESUMO
OBJECTIVES: This guideline provides recommendations for the diagnosis and management of suspected cow's-milk protein allergy (CMPA) in Europe. It presents a practical approach with a diagnostic algorithm and is based on recently published evidence-based guidelines on CMPA. DIAGNOSIS: If CMPA is suspected by history and examination, then strict allergen avoidance is initiated. In certain circumstances (eg, a clear history of immediate symptoms, a life-threatening reaction with a positive test for CMP-specific IgE), the diagnosis can be made without a milk challenge. In all other circumstances, a controlled oral food challenge (open or blind) under medical supervision is required to confirm or exclude the diagnosis of CMPA. TREATMENT: In breast-fed infants, the mother should start a strict CMP-free diet. Non-breast-fed infants with confirmed CMPA should receive an extensively hydrolyzed protein-based formula with proven efficacy in appropriate clinical trials; amino acids-based formulae are reserved for certain situations. Soy protein formula, if tolerated, is an option beyond 6 months of age. Nutritional counseling and regular monitoring of growth are mandatory in all age groups requiring CMP exclusion. REEVALUATION: Patients should be reevaluated every 6 to 12 months to assess whether they have developed tolerance to CMP. This is achieved in >75% by 3 years of age and >90% by 6 years of age. Inappropriate or overly long dietary eliminations should be avoided. Such restrictions may impair the quality of life of both child and family, induce improper growth, and incur unnecessary health care costs.
Assuntos
Aleitamento Materno , Dieta , Fórmulas Infantis , Hipersensibilidade a Leite/dietoterapia , Hipersensibilidade a Leite/diagnóstico , Proteínas do Leite/imunologia , Fatores Etários , Algoritmos , Aminoácidos/administração & dosagem , Animais , Criança , Aconselhamento , Crescimento/efeitos dos fármacos , Transtornos do Crescimento/etiologia , Gastos em Saúde , Humanos , Lactente , Educação de Pacientes como Assunto , Hidrolisados de Proteína/administração & dosagem , Qualidade de Vida , Proteínas de Soja/administração & dosagemRESUMO
BACKGROUND: An association between cow's milk hypersensitivity (CMH) and gastro-oesophageal reflux disease (GERD) in childhood has been reported in the past decade. AIM: To assess whether biopsies from the upper gastrointestinal tract of children with cow's milk sensitive GERD have a specific allergic inflammatory pattern, and to compare two different techniques for measuring inflammatory cells in gastrointestinal biopsies. METHODS: GERD was diagnosed by means of endoscopy and oesophageal pH monitoring. Hypersensitivity to cow's milk was determined by an elimination diet and cow's milk challenge. Allergic inflammatory cells in upper gastrointestinal biopsies were identified by immunohistochemistry and their numbers were assessed by two different methods-counting the number of cells/high power field and using the computerised Cast-Grid system. RESULTS: Cow's milk sensitive GERD was identified in 10 of 17 children with severe GERD (median age, 7.8 years). Biopsies from children with endoscopic oesophagitis had significantly increased numbers of mast cells and T cells. No differences in the number of eosinophils, mast cells, or T cells were found between children with CMH and those with primary GERD. Several differences were found between the two different histological quantification methods. CONCLUSIONS: CMH was found not only in infants but also in school age children with GERD. Histology did not identify the cow's milk sensitive GERD subgroup. The computerised histological method provides a more complete evaluation based upon total biopsy area, and helped to limit the bias of uneven biopsy size.
Assuntos
Eosinofilia/etiologia , Refluxo Gastroesofágico/complicações , Hipersensibilidade a Leite/complicações , Adolescente , Biópsia , Contagem de Células , Criança , Pré-Escolar , Eosinofilia/diagnóstico , Eosinófilos/patologia , Esofagoscopia , Esôfago/patologia , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/patologia , Humanos , Concentração de Íons de Hidrogênio , Lactente , Masculino , Mastócitos/patologia , Hipersensibilidade a Leite/dietoterapia , Hipersensibilidade a Leite/patologia , Linfócitos T/patologiaRESUMO
Many modern pesticides have endocrine disrupting abilities and early-life exposure may affect growth and disease risk later in life. Previously, we reported associations between prenatal pesticide exposure and higher childhood body fat content measured by anthropometry. The associations were affected by child PON1 Q192R genotype. We aimed to study whether prenatal pesticide exposure was still associated with body fat content and distribution in the children at puberty and the potential impact of both maternal and child PON1 Q192R genotype. In this prospective cohort study of 247 children born by occupationally exposed or unexposed women (greenhouse workers and controls) two follow-up examinations (age 10-15 and 11-16 years) including simple anthropometry, skinfold measurements, pubertal staging and blood sampling were performed. Total and regional fat% was determined by dual X-ray absorptiometry (DXA) at age 10-15. Prenatal pesticide exposure was associated with increased total, android, and gynoid fat percentage (DXA) at age 10-15 years after adjustment for sex, socioeconomic status, and puberty (all ß = 0.5 standard deviation score (SDS) p < 0.05). Stratified by sex, the associations were significant in girls (total fat: ß = 0.7 SDS, android-gynoid ratio: ß = 0.1, both p < 0.05), but not in boys. Carrying the R-allele (child or mother, separately, or both) augmented the differences between exposed and unexposed children (total fat: ß = 1.0 SDS, ß = 0.8 SDS, p < 0.05, respectively, and ß = 1.2 SDS, p < 0.01). No exposure-related differences were found if either the child or mother had the QQ wild-type. At age 11-16, exposed children tended to have a higher total fat% estimated by skinfolds than unexposed children (p = 0.06). No significant associations between prenatal exposure and body mass index or waist circumference were found. Prenatal pesticide exposure was associated with higher adolescent body fat content, including android fat deposition, independent of puberty. Girls appeared more susceptible than boys. Furthermore, the association depended on maternal and child PON1 Q192R genotype.
Assuntos
Adiposidade/efeitos dos fármacos , Arildialquilfosfatase/genética , Distribuição da Gordura Corporal , Praguicidas/toxicidade , Efeitos Tardios da Exposição Pré-Natal/diagnóstico por imagem , Absorciometria de Fóton , Adolescente , Índice de Massa Corporal , Criança , Feminino , Genótipo , Humanos , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/genética , Estudos Prospectivos , Puberdade , Fatores Sexuais , Fatores SocioeconômicosRESUMO
The IgG subclasses of human antibodies against 2 dietary antigens, ovalbumin (OA) and beta-lactoglobulin (BLG), were studied by ELISA using monoclonal anti-human IgG subclass antibodies. Under the assay conditions used, the anti-IgG subclass antibodies were subclass specific. Quantitative estimates of the subclass antibodies were obtained by reference to a 'capture' assay using F(ab')2 anti-light chain antibody as ligand and IgG myelomas as standards. The validity of these estimates was supported by antibody quantitation using the Farr assay. In healthy adults with serum anti-OA or anti-BLG antibodies, anti-OA antibodies were found mainly in the IgG1 (9/11) and IgG4 (6/11) subclasses, whereas 5 sera showed high levels of IgG2 antibodies. In contrast, the IgG subclass distribution of anti-BLG antibodies was predominantly IgG4 (10/10).
Assuntos
Ensaio de Imunoadsorção Enzimática , Imunoglobulina G/classificação , Lactoglobulinas/imunologia , Ovalbumina/imunologia , Adulto , Anticorpos Anti-Idiotípicos/imunologia , Anticorpos Monoclonais/imunologia , Especificidade de Anticorpos , Dieta , Feminino , Hipersensibilidade Alimentar/imunologia , Humanos , Imunoglobulina G/imunologia , Masculino , Proteínas do Mieloma/imunologiaRESUMO
We have developed a method to purify mast cells from enzymatic isolates of human colonic mucosa (HCM) and submucosa/muscle (HCS), and gastric mucosa (HGM) and submucosa/muscle (HGS). The purification of mast cells from these enzymatic isolates involves positive affinity-magnetic selection of mast cells using a monoclonal antibody specific for the c-kit receptor tyrosine kinase (CD117). The monoclonal antibody is coupled to Dynabeads for positive affinity selection of c-kit receptor positive cells which includes mast cells. This selection procedure generates preparations of mast cells from HCM, HCS, HGM and HGS that are 80% pure. The purified mast cells were microscopically normal and viable (> 85%). The functionality of purified mast cells was examined by studying the effect of anti-human IgE, Concanavalin A (Con A) and calcium ionophore A23187 on histamine release. These results show that this purification procedure generates microscopically normal, viable and functional mast cells. This method of purifying human gastrointestinal tissue mast cells may be a valuable tool for the further study of mast cell heterogeneity and the role of mast cells in the gastrointestinal tract.
Assuntos
Colo/citologia , Mastócitos/citologia , Estômago/citologia , Adulto , Idoso , Calcimicina/farmacologia , Separação Celular/métodos , Sobrevivência Celular/fisiologia , Colagenases/metabolismo , Concanavalina A/farmacologia , Mucosa Gástrica/citologia , Liberação de Histamina/efeitos dos fármacos , Liberação de Histamina/fisiologia , Humanos , Mucosa Intestinal/citologia , Ionóforos/farmacologia , Mastócitos/efeitos dos fármacos , Mastócitos/fisiologia , Pessoa de Meia-IdadeRESUMO
The mechanisms responsible for sensitization, in particular within the gastrointestinal tract, are IgE-mediated as well as of a non-IgE-mediated, immunological origin. The phenomenon that is the opposite of sensitization is the maintenance of tolerance and is exemplified by the phenomenon 'oral tolerance'. The cytokines transforming growth factor beta and interferon gamma have been shown to be key immunoregulatory cytokines in oral tolerance. A new experimental model of eosinophilic allergic gastroenteritis has been developed with the use of encapsulated dietary antigen. The model was used in mice with genetic deletions of the eosinophil chemokine eotaxin or of the cytokine IL-5, demonstrating the importance of eotaxin. In clinical allergy research, a major question has been to explain the global increase in asthma and allergy. The 'hygiene hypothesis' states that a lack of maturation of the infant immune system from a T helper 2 to a T helper 1 type of immune response may be caused by less microbial stimulation in Western societies. Several lines of data support this hypothesis. However, apart from the genetic constitution of the individual, breastfeeding in infancy may be the most important single determinant for the development of clinical tolerance.
Assuntos
Hipersensibilidade/etiologia , Tolerância Imunológica , Animais , Infecções Bacterianas/imunologia , Aleitamento Materno , Quimiocinas/fisiologia , Modelos Animais de Doenças , Humanos , Recém-Nascido , Receptores de Lipopolissacarídeos , Fatores de Risco , Linfócitos T/imunologiaRESUMO
BACKGROUND: Gastroesophageal reflux disease (GERD) and cow milk hypersensitivity are frequent disorders of infancy. A possible causative association between these two entities has been suggested. OBJECTIVE: The primary aim was to elucidate whether a causative relationship between the two entities could be established in a population of infants and children. A secondary aim was to evaluate whether cow milk challenge during esophageal pH monitoring is useful as an objective method to identify this subgroup of patients. METHODS: Upper endoscopy followed by a 48-hour esophageal pH monitoring with cow's milk elimination diet at day 1 and challenge at day 2. Cow milk hypersensitivity was later verified by elimination diet and a second open (in patients < 3 years of age) or double-blind placebo-controlled (in patients > or = 3 years of age) challenge. Skin prick test, specific serum immunoglobulin E and skin patch test were used as supplementary procedures. Follow-up endoscopy and pH monitoring were performed after 3 months of treatment (omeprazole versus elimination diet dependent on evidence of food hypersensitivity). RESULTS: Eighteen of 42 investigated patients had severe GERD, defined as endoscopic esophagitis and/or a reflux index > 10%. Among these patients, a group of 10 patients with GERD and cow milk hypersensitivity was identified. This group had a significantly higher reflux index compared with children with primary GERD. No significant increase was noted in reflux index during simultaneous pH monitoring and milk challenge. CONCLUSIONS: An association between GERD and cow milk hypersensitivity was observed in both infants and children with severe GERD. Simultaneous cow milk challenge and pH monitoring had limited value as a method to identify this subgroup.
Assuntos
Refluxo Gastroesofágico/complicações , Hipersensibilidade a Leite/complicações , Adolescente , Animais , Bovinos , Criança , Pré-Escolar , Método Duplo-Cego , Endoscopia Gastrointestinal , Esôfago/química , Refluxo Gastroesofágico/diagnóstico , Humanos , Concentração de Íons de Hidrogênio , Lactente , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/dietoterapia , Placebos , Testes CutâneosRESUMO
The role of IgG subclasses and IgG subclass antibodies in atopic disease is controversial. Serum IgG and IgG subclass (IgG1-4) antibodies to the two dietary antigens ovalbumin (OA) and beta-lactoglobulin (BLG) were measured with ELISA-methods in 16 patients with mild or moderate atopic dermatitis (AD) and healthy controls. The IgG antibodies were measured in 31 patients with previous AD and controls. The IgG subclass antibodies to OA and BLG showed predominance of IgG4 and IgG1 for both patients and controls. The levels of IgG and IgG subclass antibodies to OA did not differ between the groups, but the levels of IgG and IgG4 anti-BLG antibody were higher in patients with active AD than in controls. The antibody levels did not correlate with severity of disease or with a history of food allergy/intolerance. IgG4 antibodies to dietary antigens may be elevated in AD, but the diagnostic significance of IgG subclass antibody measurement is limited.
Assuntos
Dermatite Atópica/imunologia , Imunoglobulina G/classificação , Lactoglobulinas/imunologia , Ovalbumina/imunologia , Animais , Antígenos , Hipersensibilidade Alimentar/imunologia , Humanos , Imunoglobulina E/análise , Imunoglobulina G/análise , Leite/imunologiaRESUMO
AIM: To report the epidemiology, associated malformations, morbidity and mortality for the first 5 years of life for infants with gastrointestinal malformations (GIM). METHODS: Population-based study using data from a registry of congenital malformations (Eurocat) and follow-up data from hospital records. The study included livebirths, fetal deaths with a gestational age of 20 weeks and older and induced abortions after prenatal diagnosis of malformations born during the period 1980 - 1993. RESULTS: A total of 109 infants/fetuses with 118 GIM were included in the study giving a prevalence of 15.3 (12.6 - 18.5) cases per 10 000 births. Anal atresia was present in seven of the 9 cases with more than one GIM. There were 38 cases (35 %) with associated malformations and/or karyotype anomalies. Thirty-two of the 90 live-born infants died during the first 5 years of life with the majority of deaths during the first week of life. Mortality was significantly increased for infants with associated malformations or karyotype anomalies compared to infants with isolated GIM (p < 0.01). An uneventful surgical course was reported for 74 % of the 58 survivors. CONCLUSIONS: The prognosis for infants with GIM is highly dependent on the presence of associated malformations or karyotype anomalies. Surgery for GIM can be performed with low mortality. Morbidity is high for a small group of infants, but the majority of survivors have an uncomplicated surgical course.
Assuntos
Anormalidades do Sistema Digestório , Canal Anal/anormalidades , Anormalidades Congênitas/epidemiologia , Dinamarca/epidemiologia , Duodenopatias/epidemiologia , Atresia Esofágica/epidemiologia , Gastrosquise/epidemiologia , Idade Gestacional , Hérnia Diafragmática/epidemiologia , Hérnia Umbilical/epidemiologia , Humanos , Recém-Nascido , Atresia Intestinal/epidemiologia , Morbidade , Prevalência , PrognósticoRESUMO
Endogenous immunoglobulin in tissue sections pose a problem in immuno-histochemical techniques employing homologous antibody as primary reagents and enzyme-labelled anti-immunoglobulin for the development. A method for the blocking of endogenous immunoglobulin in human tissue sections by incubation with monomeric pepsin fragments (Fab') of rabbit anti-human immunoglobulin before applying monoclonal antibody was evaluated for the screening of human monoclonal antibody. It was initially demonstrated that Fab' rabbit anti-human IgM and anti-IgG could block endogenous immunoglobulin in human IgM and IgG producing tumors thereby abolishing the binding of subsequently applied peroxidase-labelled anti-IgM or anti-IgG. Frozen sections of human colo-rectal adenocarcinomas show a variable background staining caused by the endogenous immunoglobulin. The background completely disappeared in the IgM system by preincubation with Fab' anti-IgM while the background was clearly reduced but not abolished in the IgG system. A human hybridoma supernatant containing IgM reactive with colo-rectal adenocarcinoma could easily be screened on frozen sections using this method. This approach should be generally useful for the screening of human antibody on human tissue sections.
Assuntos
Anticorpos Monoclonais , Hibridomas/imunologia , Imunoglobulinas/análise , Linfoma/imunologia , Plasmocitoma/imunologia , Neoplasias do Colo/imunologia , Neoplasias do Colo/patologia , Humanos , Imunoglobulina G/análise , Imunoglobulina M/análise , Linfoma/patologia , Plasmocitoma/patologia , Neoplasias Retais/imunologia , Neoplasias Retais/patologiaRESUMO
The aim of this prospective, randomised, double blind study was to evaluate whether inhaled nebulized corticosteroid is effective in the treatment of croup. Thirty-seven children (aged 0.4-4.9 years) admitted to hospital with moderate to severe croup were allocated to treatment with either 2 mg nebulized budesonide (20) or saline (17). Disease severity was assessed by a clinical croup score based on stridor, cough, retractions, dyspnoea and cyanosis, and the overall clinical assessment was scored on a visual log scale (0-100). Two hours after treatment there was a significant improvement in croup score in the group treated with budesonide (8 to 4.5), but not in the group treated with saline (8 to 8). Furthermore, the overall clinical assessment score decreased significantly (50 to 25) in the group treated with budesonide, whereas it remained constant in the placebo group (60 to 62). The results indicate that nebulised budesonide can be used as a safe and effective alternative treatment in children with moderate to severe croup.
Assuntos
Broncodilatadores/administração & dosagem , Crupe/tratamento farmacológico , Pregnenodionas/administração & dosagem , Administração por Inalação , Aerossóis , Budesonida , Pré-Escolar , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Placebos , Estudos ProspectivosRESUMO
INTRODUCTION: Gastrointestinal endoscopy in children is a well-established procedure. We reviewed our experience of endoscopy in infants below one year of age to evaluate indications, endoscopic findings, histology, and complications. MATERIAL AND METHODS: Twenty-eight infants were studied over a two-year period. Of these, 18 underwent upper endoscopy, six recto/sigmoidoscopy or colonoscopy, and four both procedures. RESULTS: The most common indication (10/22) for upper endoscopy was vomiting and suspicion of gastrooesophageal reflux disease. In these infants, 24-hour continuous monitoring of the oesophageal pH followed the procedure. Indications for lower endoscopy were rectal bleeding (n = 6) and intractable diarrhoea (n = 4). There were no complications to anaesthesia, endoscopy, or biopsy. Overall, there were endoscopic abnormalities in 82% and histological abnormalities in 75% of the infants. The diagnostic findings included rare disorders, such as eosinophilic gastroenteritis, microvillous inclusion disease, and chylomicron retention disease. Diagnosis of these diseases requires gastrointestinal biopsy. DISCUSSION: Gastrointestinal endoscopy is a safe procedure, which is a valuable part of the diagnostic work-up in a selected group of infants with long-lasting or severe gastrointestinal symptoms.