Dumping syndrome: a common problem following Nissen fundoplication in young children.

Within a 3-year period we observed six children, aged 3 months to 4 years, with dumping syndrome (DS) following Nissen fundoplication. Five were neurologically normal and one was slightly mentally retarded. Symptoms included postprandial tachycardia, diaphoresis, lethargy, severe retching, meteorism or gas-bloat syndrome, watery diarrhea, refusal to eat with failure to thrive, and developmental delay. Results of an oral glucose tolerance test did not correlate with the severity of symptoms. In one child severe retching led to recurrent paraesophageal gastric herniation, necessitating two reoperations and a gastrostomy. A lack of meal stimulated pancreatic polypeptide release in this patient indicated vagal damage. Initially five of the six children needed continuous intragastric feeding until bolus application of a carbohydrate-modified diet was tolerated. We conclude that the diagnosis of DS is often delayed in spite of characteristic clinical signs. Intensive postoperative follow-up after antireflux surgery should be mandatory in children.

[Growth retardation and dystrophy in Crohn's disease]. / Minderwuchs und Dystrophie bei Morbus Crohn.

A 14 year old boy with Crohn's disease of the small bowel had a seven year history of growth failure and severe dystrophy. This case demonstrates the significance of growth failure, catch-up growth and intestinal obstruction for children with Crohn's disease.

[Femur head necrosis in sickle cell anemia]. / Hüftkopfnekrose bei Sichelzellanämie.

The clinical course and therapy of femoral head necrosis after a minimal trauma in a 14 year old Turkish girl with sickle cell anemia is described. In this hemoglobinopathy one must be aware of complicated clinical courses even after minor accidents. The immediate start of therapy in an acute crisis and the early diagnosis of bone infarction and femoral head necrosis are necessary to avoid large bone defects.

[Gianotti-Crosti syndrome. HBsAG-negative papular acrodermatitis, an infantile papulovesicular acrolocalized syndrome]. / Gianotti-Crosti-Syndrom. HBsAG-negative papulöse Akrodermatitis, infantiles papulovesikulöses akrolokalisiertes Syndrom.

We report three cases of the Gianotti-Crosti syndrome (papulovesicular-acro-located syndrome of childhood), a self-limited common disease of childhood, which may be caused by various viral infections. The hepatitis B virus, however, is excluded by definition as a causal agent. The syndrome is characterized by itching papulo-vesicular skin lesions measuring 1-5 mm in diameter and localized to the limbs and face. The clinical and terminological differences between the HBsAG negative Gianotti-Crosti syndrome and the HBsAG positive Gianotti disease are emphasized.