Manometrical evaluation in visceral neuropathies in children.

Manometrical recordings were made at three levels of the digestive tract in 20 children with chronic intestinal pseudoobstruction (CIPO) defined clinically and histopathologically by deep biopsies showing a neuropathic process. Duodenal manometry showed severe abnormalities with hypomotility in all cases and absence of migrating motor complex in 13 of 20 cases. There was no relation between the histopathologic type and the motility pattern, but the most severe abnormalities were seen in the patients with extensive involvement of the digestive tract and the most severe clinical course. Esophageal manometry was abnormal in 18 of 19 patients, with altered peristalsis consisting of simultaneous, short-lasting, or low-amplitude waves. Rectoanal manometry showed the presence of the rectosphincteric inhibitory reflex in all patients. In conclusion, there is a high frequency of small bowel manometrical abnormalities in CIPO which seem to correlate with the extent of the pathological process and the prognosis of the disease. Esophageal manometry is useful for defining the extent of dysmotility and confirming the diagnosis of CIPO in some cases.

Duodenal manometry in postobstructive enteropathy in infants with a transient enterostomy.

Intestinal motility was studied in 11 children with a transient enterostomy secondary to a neonatal organic small intestine obstruction (5 total colon Hirschsprung's disease, 2 necrotizing enterocolitis, 1 intussusception, 3 ileal atresia). Eight children presented with a postobstructive enteropathy (severe grade I [5], moderate grade II [3]) and three were considered as controls (grade III). They were assigned to one of the three groups on the basis of the duration of parenteral nutrition and constant rate enteral nutrition needed and the oral feeding tolerance. Barium small intestine transit showed no persistent partial obstruction or peritoneal adhesions. The abnormal inert marker transit times were statistically correlated with the clinical groups as well as duodenal manometric abnormalities. Manometric recordings were characterised by the absence (grade I) or abnormal phase III (grade II) of the migrating motor complex and decreased motility index (grades I and II). This study confirms that this enteropathy is due to a chronic alteration in motility induced by prenatal or postnatal obstructions.

[Evaluation of vaccine coverage in children under two years of age in Kinshasa (Zaire)]. / Evaluation de la couverture vaccinale des enfants de moins de 2 ans à Kinshasa (Zaïre).

BACKGROUND: Despite efforts to make immunization against preventable diseases available to all children in Zaire, only about 33% of the children living at Kinshasa were immunized in 1986. METHODS: The compliance with the vaccination schedules was evaluated in 211 children less than 2 years of age consulting in the largest medical center of Kinshasa during one week in September 1989. Socio-demographic data on the parents and histories of infectious preventable diseases in children were also collected. RESULTS: 93% of the children were immunized against tuberculosis, 85% against diphtheria, tetanus, pertussis and poliomyelitis, 76% against measles. Compliance with the vaccination schedule was higher when the mothers were better educated, or when they worked in the public service. 25% of the children had not been immunized against measles at the age of 9 months. CONCLUSION: The vaccine schedule and the strategy must still be improved.

[Clinical manifestations of AIDS in children in Kinshasa]. / Manifestations cliniques du SIDA chez l'enfant à Kinshasa.

Clinical features observed in 60 cases of childhood HIV infection at the Cliniques Universitaires of Kinshasa is reported. Exposure mode, demonstrated in 92% of cases, was essentially maternofetal (65%) and related to blood transfusion (27%). The clinical signs appeared the first year of life in children born to seropositive mothers (82%). The main clinical features were: failure to thrive, high recurrent fever, persistent cough, chronic diarrhea, recurrent respiratory infections, hepatosplenomegaly, generalized lymphoadenopathy and oral candidiasis. Pulmonary lesions were very common (90%). These lesions were related to bacteria in 20 cases, to tuberculosis in 17 cases and to interstitial pneumonitis in 20 cases.

Visceral neuropathies responsible for chronic intestinal pseudo-obstruction syndrome in pediatric practice: analysis of 26 cases.

Twenty-six children aged from 1 day to 15 years (18 boys and 8 girls) with visceral neuropathies are analyzed. Clinical symptomatology is dominated by abdominal distension, attacks of occlusion, abdominal pain, and malnutrition. Intestine bacterial overgrowth is frequent. From aspiration biopsies, surgical rectal biopsies, and, in some cases, ileal or ileocolic biopsies, histopathological studies revealed two patterns. One group had abnormalities of the myenteric plexus identified by conventional light microscopic studies, with two patterns: [myenteric plexus hyperplasia (9 patients), characterized by large ganglionic nodes, penetration into the mucosal zone, and altered argyrophilic neurons]. Clinically this pattern was observed in four patients with multiple endocrine neoplasia syndrome with risk of medullary thyroid carcinoma. The second pattern observed was characterized by glial cell hyperplasia (15 patients). Ganglion cells are present but are small and sparse, often infiltrated by collagen tissue; Schwann nerve fibers are hypertrophic. Eleven patients presented with neonatal intestinal obstruction. The second group is characterized by normal conventional light microscopic examination, but silver stains revealed important abnormalities of argyrophobic cells (one case) or argyrophilic cells (one case). In the two groups, most of the patients needed intestinal derivation and prolonged nutritional support with total parenteral nutrition.

[Recto-colic polyps in the child. Analysis of 183 cases]. / Polypes recto-coliques de l'enfant. Analyse de 183 cas.

Between January 1974 and April 1988, 1,533 colonoscopy were carried out in children less than 15 years old. Two hundred and seventy-four polyps were demonstrated in 183 children (106 boys, 77 girls, mean age: 6 years). The main symptom in most cases was rectal bleeding during defecation. A family history of polyps or digestive cancer was found in 6% of all patients. Two hundred and thirty-nine polyps were removed by endoscopic resection, 232 of them by the diathermic snare and 7 by William's hot biopsy technique. Histological examination of 129 polyps revealed a juvenile polyp in 125 cases, an hyperplastic polyp in 2 cases, a lymphoid polyp in 1 case and an adenoma in 1 case. No complications were observed except for one case each of hemorrhage and perforation following endoscopic polypectomy.

[Value of esogastroduodenal endoscopy with staged biopsies in children with Crohn's disease]. / Intérêt de l'endoscopie oeso-gastro-duodénale avec biopsies étagées chez des enfants suspects de maladie de Crohn.

An upper gastrointestinal endoscopy with multiple biopsies was performed in 19 children suspected of Crohn disease (CD) who had also undergone X-ray investigations and colonoscopy with multiple biopsies. Biopsies were performed in pathological and/or normal mucous areas. Upper gastrointestinal endoscopy showed macroscopic changes in 7 children (37%). Histologic examinations of the upper gastrointestinal tract were normal or showed only non specific changes in 12 cases (63%). Histopathologic changes specific for CD were found in 7 cases (37%), while specific histologic changes were identified at the rectal or colic level in 3 of these 7 cases only. Thus, upper gastrointestinal endoscopy with multiple biopsies was most useful for the diagnosis of CD, since it was the only diagnostic means in 4 cases. It should be systematically performed when CD is suspected.