Complementary, alternative, integrative and dietary therapies for children with Crohn's disease - A systematic review.

Children with diagnosed inflammatory bowel diseases such as Crohn's disease are faced with the daunting prospect of living with a chronic disease. Besides psychological stress, children are suffering from therapy side-effects; in particular, corticosteroid therapies are problematic in the growth phase. This highlights that there is a need for less aggressive alternative therapies for children as well as adolescents living with such chronic conditions. Elemental diets are widely used and accepted therapy options. Several pediatric Crohn's disease patients also use complementary, alternative and integrative therapies to reduce or avoid drug therapies. To survey such therapy options and their efficiency and safety, we performed a systematic literature search and screened databases (Cochrane Library, EMBASE, OvidSP, PubMed, CAMbase, CAM-QUEST, Anthromedics) from their inception to December 2019. In total, seven of 1439 studies fulfilled search criteria. Six RCTs and one retrospective controlled trial investigating elemental diets (Flexical, Elemental 028), semi-elemental diets (Pregomin), polymeric diets (Modulen IBD), whole protein based formulas, and ω-3 fatty acid supplementation were found. Data indicated that diet therapies were equal to or more effective than corticosteroid therapies when used to treat Crohn's disease. Regrettably, we could not identify controlled studies investigating complementary, alternative and integrative medicine approaches. Our review provides an updated overview of controlled studies investigating dietary therapies used in the treatment of pediatric Crohn's disease, and demonstrates that the current study situation does not reflect the actual use of complementary, alternative and integrative therapies. Therefore, clinical trials are necessary to estimate risks and benefits of such therapies. The review indicated that enteral diets and ω-3 fatty acid supplementation may be an effective alternative to corticosteroid treatments for children with Chron's disease.

Complementary and alternative medicine in the treatment of acute bronchitis in children: A systematic review.

OBJECTIVE: Our review summarizes published literature of complementary and alternative medicine (CAM) used for the treatment of acute bronchitis in children. BACKGROUND: Acute bronchitis is one of the most frequent pediatric diseases and has high prevalence for in- and outpatient care. Acute bronchitis is mainly a viral-caused infection, but a high and inappropriate use of antibiotics has been demonstrated in many countries. As CAM therapies might reduce the use of antibiotics and can complement conventional therapies in children, they could be an appropriate treatment option. METHODS: A systematic literature search was conducted using general and complementary and alternative medicine (CAM)-specific databases. A search term including 65 CAM-associated definitions was applied. RESULTS: Literature search revealed 309 articles, whereby 18 articles hit search criteria. These clinical trials were subgrouped into the categories herbal medicine, anthroposophic medicine and homeopathy. The most often studied approaches are herbal remedies, in particular the Pelargonium sidoides extract, EPs® 7630. Its efficacy was demonstrated in three placebo-controlled trials and two observational studies. Anthroposophic approaches (mainly ribwort-containing remedies) were investigated in two controlled trials and three observational studies. Two studies were found investigating the homeopathic remedies Monapax® and Droperteel®. CONCLUSION: Study results indicate a favorable effect of investigated CAM approaches. However, only three of 18 studies were randomized controlled trials (RCTs), so a reliable statement on effectiveness was not possible and further RCTs are indispensable.

An expert consensus-based guideline for the integrative anthroposophic treatment of acute gastroenteritis in children.

OBJECTIVES: Acute gastroenteritis is one of the major causes of hospital admission in childhood. The primary objective of the treatment is rehydration, but conventional drug therapies are limited. Therefore, several pediatricians supplement conventional treatment with complementary and alternative therapies. In the two German departments for pediatric integrative medicine, children suffering from an acute gastroenteritis are treated with supportive therapy based on anthroposophic medicine. However, up to now scientifically validated guidelines for these therapies are lacking. DESIGN: We consulted an expert pool of 50 physicians with expertise in anthroposophic medicine as well as pediatrics and invited them to participate in an online-based Delphi process. Results were analyzed by means of qualitative content analysis with two independent raters using MAXQDA. Using four rounds of questioning, a consensus-based guideline was developed. RESULTS: A strong consensus (>90%) or consensus (>75-90%) was achieved for 14 of 16 subsections. The guideline describes disease characteristics, the most useful diagnostics, drug as well as non-drug treatment recommendations and advises for a good physician-patient interaction. CONCLUSION: The guideline will help clinicians, as well as family doctors, in their daily routine and make anthroposophic medicine more tangible for parents and health insurance companies.

Nodal anaplastic large-cell lymphoma ALK-1- with CD30+ cutaneous lymphoproliferation treated with mistletoe: spontaneous remission or treatment response?

A 12-year old girl presented with general weakness and weight loss, a localised cervical lymph node enlargement and cutaneous lesions compatible with lymphomatoid papulosis (LyP). Biopsies from lymph node and skin revealed a histological diagnosis of nodal large cell ALK-1- anaplastic lymphoma (ALCL) with a synchronous CD30+ cutaneous lymphoproliferation consistent with lymphomatoid papulosis (LyP). The girl was treated with mistletoe (MT) as monotherapy. Within 1 week after initiation of MT-treatment the skin lesions and lymph node enlargement improved. Under continuing MT-therapy 30 months after diagnosis the patient is still in complete remission. It is not possible to know whether this was a rare case of spontaneous remission of the nodal and skin-manifestations of this CD30+ T-cell lymphoproliferation or whether the observed effect was a specific therapeutic response to MT-treatment.

[Clinical courses of trisomy 18 (Edwards syndrome) - an update]. / Klinische Verläufe bei Trisomie 18 (Edwards-Syndrom) - Ein Update.

BACKGROUND: In current literature the prognosis of trisomy 18 is mainly described as inevitably lethal. After intervention of parental organisations infants have been treated with cardio surgery in the USA, later in Europe as well with good results. We report the consequences of this and similar developments on our pre- und postnatal approach after diagnosis in our department. PATIENTS AND CASE REPORTS: 2 parents decided to carry the child to term after the recommendation for abortion. According to standard perinatological aspects one child was vaginally delivered, the second with Caesarean section. After informed consent with the parents we planned a supportive management without more resuscitation than stimulation and ventilation by mask. Both children could be stabilised with nasal CPAP. The first one had been operated on a double outlet right ventricle at the age of 6 months, the second needed to be operated for diaphragm hernia. The third child had been delivered by emergency Caesarean section. A bilateral choanal atresia had been operated in the first week of life, a double outlet right ventricle at the age of 15 days. One child is fed by a nasogastric tube, one is bottle-fed and one had a percutanous gastric tube until he died due to septicaemia, all have statomotorically retardation and had periods of pulmonary hypertension. The social situation of the families is characterised by a stable parental relationship and a safe socio-economical status. None of the children had an acute lethal malformation. DISCUSSION: In single cases a prospective management in patients with trisomy 18 can be possible. Besides medical issues, the emotional parental wish, their social network and economical status are crucial. CONCLUSION: The prognosis of trisomy 18 is poor. 3 patients and 20 months do not allow any general statements. However, our recent experience and the courses in the recent literature show that in single cases a more prospective management is possible.

Paraneoplastic myopathy as a very rare manifestation of acute lymphoblastic leukemia.

We present a 9-year-old girl who developed acute muscular weakness of proximal muscles of the upper and lower limbs. Investigations revealed a common acute lymphoblastic leukemia. The neuromuscular symptoms are classified as a paraneoplastic neurological syndrome (PNS). Under chemotherapy according to ALL-BFM-2000 protocol symptoms resolved within 4 weeks. This case presents a rare manifestation of acute lymphoblastic manifestation.

[Relevance and barriers of physician empathy in daily practice - current state of research and qualitative survey of physicians]. / Bedeutung und Barrieren ärztlicher Empathie im Praxisalltag - Stand der Forschung und qualitative Kurzumfrage mit Ärzten.

AIMS OF THE STUDY: The aim of this study was to investigate the relevance and the barriers of physician empathy in medical rehabilitation by conducting a narrative literature review and a qualitative survey in physicians. METHODS: First, we described the current state of research of physician empathy in medical rehabilitation based on a narrative (non-systematic) review of the literature. Additionally, the questions of relevance and barriers of physician empathy were examined in a qualitative short survey with physicians from Rehabilitation Medicine, Internal Medicine, Pediatric and Family Medicine. The qualitative data were analyzed according to the summarizing content analysis of Mayring. RESULTS: Only n=13 studies of physician empathy were conducted in Rehabilitation Medicine; of those, just a few were from Germany and a small number investigated the influence of empathy on patient health outcomes. The qualitative survey's results regarding the definition, patient outcomes and barriers of physician empathy are similar to other theoretical and empirical studies on those issues. Moreover, they show many new, practical aspects, particularly in the field of barriers of physician empathy. CONCLUSION: Although physician empathy has been shown to be an outcome-relevant factor in acute health care, less attention has been paid to it in Rehabilitation research. Physicians from Rehabilitation Medicine, Internal Medicine, Pediatric and Family Medicine perceive empathic behavior also as an outcome-relevant ability, which is particularly hindered by time pressure and stress but also by personal and patient-specific factors.

[Neonatal seizures caused by lamotrigin withdrawal?]. / Neugeborenen-Krämpfe durch Lamotrigin-Entzug?

We report about a 3-day-old full-term newborn who suffered from series of tonic-clonic and myoclonic seizures. His mother was treated with lamotrigin for epilepsy. It is worthy of note that the drug level of the neonate had already decreas-ed to 37% of the basic level of his mother. At the same time, there was a catabolic metabolic situation and a mild hyponatriaemia. We believe that the neonatal seizures were caused by lamotrigin withdrawal.

[Complementary and alternative medicine in pediatric oncology]. / Komplementäre und alternative Behandlungsmethoden in der Kinderonkologie.

For many families of pediatric cancer patients the use of complementary and alternative medicine (CAM) is an accepted adjunct to conventional therapy, even if data regarding effects and risks are scarse. This report provides information about the prevalence of CAM use and reasons for CAM use among pediatric cancer patients. Frequently used CAM like nutrition (incl. diets and vitamins), homeopathy, anthroposophic medicine, phytotherapy, and acupuncture are highlighted, as were CAM bearing a special risk for their users. Physicians need to be more aware that a substantial percentage of their patients may use CAM without telling them for different reasons. Physicians need to be open-minded and should discuss CAM with parents. A differentiation between potentially useful and potentially dangerous CAM is necessary aiming at minimising the risks for CAM users.

[Parents-interview on use of complementary and alternative medicine in pediatric oncology in Germany]. / Elternbefragung zur Anwendung alternativer und komplementärer Behandlungsmethoden in der Kinderonkologie in Deutschland.

BACKGROUND: There are no published data on the use of complementary and alternative medicine (CAM) in pediatric oncology in Germany. PATIENTS/METHOD: All parents of children, who where diagnosed a disease registered in the German Childhood Registry in 2001 were sent a questionnaire to evaluate possible CAM-use. RESULTS: 1 602 questionnaires were sent to the families, from whom 1 063 sent the questionnaire back to us. They reported a 35 % CAM-use-rate. The probability to use CAM was positively influenced by preexisting experience with CAM, higher social level and poor prognosis. 71 % of the users discussed the CAM-use with a physician. The reason for CAM-use seldom was missing trust in conventional medicine. 89 % of the CAM-users would recommend CAM-use to other parents in a comparable situation. CONCLUSIONS: The reported CAM-use rate of 35 % in pediatric oncology in Germany is as reported in the international literature for other European countries. Essential parts of CAM-advise and -prescription are done by non-professionals, so that there is a need to get competence in CAM in pediatric oncology in Germany.

Topotecan in the treatment of refractory neuroblastoma and other malignant tumors in childhood - a phase-II-study.

BACKGROUND: The topoisomerase-I-inhibitor Topotecan (TPT) has shown a broad activity in the therapy of adult malignant diseases. In pediatric oncology TPT has been rarely used. METHODS: From 1/98 to 8/99 we conducted a multicenter phase-II-study of TPT (1.5 mg/m (2)/d in 30 min i. v. for 5 days every 21 days) in pediatric patients (pts) with malignant tumors refractory to conventional therapy (either second line or any relapse). PATIENTS: A total of 20 pts received 81 cycles. The 7 female and 13 male pts had a median age of 10.2 years at the beginning of the TPT therapy. RESULTS: The median number of administered TPT cycles was 4 with an interval of 23.5 days. The median administered TPT dose was 1.48 mg/m (2)/d. No complete responses, but 2 partial responses and 9 stable diseases were observed. In 9 pts the disease progressed. The mean duration until progression for SD was 130 and not different from PR with 131 days. The median cumulative TPT dose until progression in responders was 30 mg/m (2). For all study-pts the median overall survival time was 235 days with 1 pt. still alive. The main toxicity was hematological with anemia grade III/IV (10/42 % of all evaluable TPT cycles), neutropenia grade III/IV (49/18 %) and thrombopenia grade III/IV (35/36 %). Non-hematologic toxicity was mild with the exception of 4 cycles with infection grade III and 1 grade IV. No patient died of therapy-related complications. CONCLUSIONS: TPT as monotherapy has shown an antitumor activity in pediatric pts with various malignancies. Toxicity was mainly hematological and manageable. Further evaluation of TPT treatment is planned using combinations with other cytostatic drugs.

[Recurrent pancreatitis in pediatric ulcerative colitis--a case report]. / Rezidivierende Pankreatitis bei kindlicher Colitis Ulcerosa--ein Fallbericht.

We report on a 12 years old girl with ulcerative colitis, who after a two years course of her disease developed a concomitant idiopathic pancreatitis. We discuss the causes of acute pancreatitis in childhood in view of the presented case summarizing the current literature. In the literature we found only two other children with ulcerative colitis and idiopathic pancreatitis. Both patients were colectomised as our patient did. Six months after colectomy she is still free of symptoms.

The penetration of misonidazole into a mature structural cartilage.

Mature cartilage may be expected to contain populations of hypoxic cells as a result of the tissues lack of direct vascularization and structure; it may therefore be at risk from possible radiosensitization. The hypoxic-cell radiosensitizing drug misonidazole Ro-07-0582 (MISO) was administered i.v. to mature New Zealand White rabbits at a dose of 100 mg/kg, and the resulting drug concentrations in both blood and ear-cartilage samples measured by HPLC. Samples were taken at regular intervals up to 4 h after administration of MISO. Blood concentrations of MISO rose rapidly to 240 microgram/ml within 5 min of administration, before falling steadily, with a t1/2 of 45 min. Cartilage levels reached a peak of 70% of the blood levels approximately 30 min after administration. The levels of MISO then fell, with a t1/2 of 44 min.