[Gastrointestinal symptoms and problems in children cared by pediatric palliative care teams. Observational study]. / Síntomas y problemas gastrointestinales en niños asistidos por equipos de cuidados paliativos pediátricos. Estudio observacional.

Gastrointestinal symptoms and problems (GI- SP) frequently cause discomfort and suffering in pediatric patients with life-threatening and/or life-limiting illnesses (LTI/LLI). Pediatric palliative care (PPC) professionals should be aware of them and perform a comprehensive approach. OBJECTIVE: To determine the prevalence of GI- SP in patients treated in PPC units and to describe the pharmacological and non-pharmacological measures prescribed. PATIENTS AND METHOD: Observational, prospective, multicenter, prospective study in patients with LTI/LLI, seen by PPC teams in Uruguay. The variables analyzed included age, sex, origin, type of LTI/LLI, presence of mucositis, vomiting, swallowing disorders, abdominal pain, constipation, diarrhea, digestive bleeding, problems with digestive prosthesis, and prescribed pharmacological and non-pharmacological treatment. RESULTS: 10 out of 16 PPC teams participated. 96 out of 436 patients seen presented GI- SP (22%). Median age was 4.2 years (1 month-18 years). LTI/LLI: 65% neurological and 7% oncological. The 96 patients had 114 consultations; 50% had 2 or more GI- SP per consultation. GI- SP observed: swallowing disorders (57%), constipation (53%), nausea and/or vomiting (24%), gastrostomy problems (17%), abdominal pain (10%), digestive bleeding (3%), and diarrhea (2%). There were variable prescriptions of pharmacological and non-pharmacological measures; only 50% of those with swallowing disorder received speech and hearing therapy. CONCLUSIONS: GI- SP motivated consultations in all PPC settings, frequently due to 2 or more GI- SP. Swallowing disorders and gastrostomy complications are frequent but not very visible problems in PPC. According to the comprehensive approach, pharmacological and non-pharmacological measures were implemented.

Telehealth for Pediatric Disorders of Gut-Brain Interaction During the COVID-19 Pandemic.

A retrospective chart review was completed to examine psychological treatment duration and response among pediatric patients with a disorder of gut-brain interaction including functional abdominal pain and irritable bowel syndrome. Cognitive behavioral therapy (CBT) was delivered via telehealth with a licensed psychologist or supervised psychology trainee embedded in a pediatric gastroenterology clinic. Participants were 22 youth (mean age = 14.36 years) who received CBT via telehealth between February and September of 2021, after completing an initial evaluation between February and July of 2021. Patients completed reliable and valid self-report measures of functional disability and pain during treatment. A unique CBT model was employed with an initial focus on psychoeducation and function regardless of level of severity of functional impairment. Consistent with study hypotheses, nonparametric statistical analyses demonstrated statistically significant reductions in functional disability and pain following implementation of the CBT model via telehealth. Contrary to predictions, there was no relation found between severity of functional impairment and duration of treatment.

Cognitive Behavior Therapy Tailored to Anxiety Symptoms Improves Pediatric Functional Abdominal Pain Outcomes: A Randomized Clinical Trial.

OBJECTIVES: To evaluate the feasibility of a stepped care model, and establish the effect of a tailored cognitive behavioral therapy, the Aim to Decrease Anxiety and Pain Treatment (ADAPT), compared with standard medical treatment as usual on pain-related outcomes and anxiety. STUDY DESIGN: Eligible patients between the ages of 9 and 14 years with functional abdominal pain disorders (n = 139) received enhanced usual care during their medical visit to a gastroenterologist. Those that failed to respond to enhanced usual care were randomized to receive either a tailored cognitive behavioral therapy (ADAPT) plus medical treatment as usual, or medical treatment as usual only. ADAPT dose (4 sessions of pain management or 6 sessions of pain and anxiety management) was based on presence of clinically significant anxiety. Outcomes included feasibility, based on recruitment and retention rates. Response to ADAPT plus medical treatment as usual vs medical treatment as usual on pain-related outcomes and anxiety measures was also investigated using a structural equation modeling equivalent of a MANCOVA. Anxiety levels and ADAPT dose as moderators of treatment effects were also explored. RESULTS: Based on recruitment and retention rates, stepped care was feasible. Enhanced usual care was effective for only 8% of youth. Participants randomized to ADAPT plus medical treatment as usual showed significantly greater improvements in pain-related disability, but not pain levels, and greater improvements in anxiety symptoms compared with those randomized to medical treatment as usual only. Anxiety and ADAPT treatment dose did not moderate the effect of treatment on disability nor pain. CONCLUSIONS: Tailoring care based on patient need may be optimal for maximizing the use of limited psychotherapeutic resources while enhancing care. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03134950.

A Core Outcome Set for Clinical Trials in Pediatric Functional Abdominal Pain Disorders.

OBJECTIVE: To ensure consistency and reduce outcome measure reporting heterogeneity in clinical trials on pediatric functional abdominal pain disorders (FAPDs), a core outcome set (COS) was developed for pediatric FAPD trials. STUDY DESIGN: A mixed-method 2-round Delphi technique was used and key stakeholders, including healthcare professionals (HCPs), patients with FAPD, and their parents were invited to participate. In the first round, key stakeholders identified outcomes of importance through an open-ended questionnaire. Outcomes mentioned by ≥10% of the participants were included in a shortlist. In the second round, this shortlist was rated and prioritized. During a consensus meeting with an expert panel, the final COS was defined. RESULTS: The first round was completed by 152 of 210 (72%) HCPs, 103 (100%) parents, and 50 of 54 (93%) patients. A total of 104 from 167 (62%) HCPs, 102 (100%) parents, and 53 (100%) patients completed round 2. Pain intensity, pain frequency, quality of life, school attendance, anxiety/depression, adequate relief, defecation pattern (disease specific, irritable bowel syndrome), and adverse events were included in the final COS for FAPDs. CONCLUSION: A set of 8 core outcomes has been identified that should minimally be measured in pediatric FAPD trials. Implementation of the use of this COS will increase comparison between studies and, therefore, improve management of children with FAPDs.

Acute superior mesenteric venous thrombosis results in high rates of readmission and morbidity.

OBJECTIVE: Superior mesenteric venous thrombosis (MVT) is a poorly understood clinical entity, and as such, outcomes are poorly described. This study aimed to identify predictors of bowel ischemia after MVT and to compare outcomes for patients treated medically (group 1) with those for patients treated with bowel resection (group 2). METHODS: This was a retrospective, single-institution study capturing all patients diagnosed with symptomatic acute MVT on computed tomography imaging from 2008 to 2018. Demographics, comorbidities, imaging, laboratory values, and treatment were included. Predictors of bowel resection were analyzed by univariate and multivariate statistics. Outcomes including mortality, readmissions for abdominal pain, and chronic mesenteric venous congestion were compared using χ2 test. RESULTS: There were 121 patients included in the study; 98 patients were treated medically (group 1), 19 patients were treated with bowel resection (group 2), and 4 patients were treated with endovascular recanalization (group 3). Group 1 and group 2 were compared directly. Patients requiring bowel resection tended to have higher body mass index (P = .051) and a hypercoagulable disorder (P = .003). Patients who required bowel resection were more likely to present with lactic acidosis (P < .001) and leukocytosis (P < .001) with bowel wall thickening on scan (P < .001). On multivariable analysis, a genetic thrombophilia was a strong predictor of bowel ischemia (odds ratio, 3.81; 95% confidence interval, 1.12-12.37). One-year mortality and readmission rates did not differ between groups. However, readmission rates for abdominal pain were high for both groups (group 1, 44.90%; group 2, 57.89%; P = .317), and a significant proportion of patients exhibited chronic mesenteric venous congestion on repeated scan (group 1, 42.86%; group 2, 47.37%; P = .104). CONCLUSIONS: A genetic hypercoagulable disorder is a predictor of bowel ischemia due to MVT. Regardless of treatment, outcomes after MVT are morbid, with high rates of readmission for abdominal pain. An alternative approach to treat these patients is needed, given the poor outcomes with current strategies.

Probióticos en el síndrome de intestino irritable con predominio de diarrea / Probiotics for the treatment of diarrhea predominant irritable bowel syndrome

Una mujer de 36 años, diagnosticada con síndrome de intestino irritable a predominio de diarrea (SII-D) acude a la consulta médica. Ella pregunta si el uso de probióticos sería útil para controlar los episodios de diarrea, ya que los fármacos con los que está siendo tratada no le resultan eficaces. Se realizó una búsqueda bibliográfica con el objetivo de en contrar evidencia en respuesta a su consulta, tras la cual se seleccionaron dos ensayos clínicos y una revisión sistemática. Se evidenciaron diversos resultados en cuanto al uso de probióticos en el SII-D y se discutieron los riesgos y beneficios del tratamiento, así como las implicancias en la vida de la paciente. (AU)

A 36-year-old woman diagnosed with diarrhea predominant irritable bowel syndrome (D-IBS) goes to meet the doctor. She raises whether the use of probiotics would be useful for controlling diarrhea episodes, since the drugs which she is being treated with, are not effective. A bibliographic search was conducted with the objective of finding evidence in response toher query. Two clinical trials and a systematic review were found. Variable results were found regarding the use of probioticsin D-IBS. The risks and benefits of the treatment were discussed, as well as the implications in the patient's lifestyle. (AU)

Gastrointestinal motility and absorptive disorders in patients with inflammatory bowel diseases: Prevalence, diagnosis and treatment.

Inflammatory bowel diseases (IBD), Crohn`s disease and ulcerative colitis, are chronic conditions associated with high morbidity and healthcare costs. The natural history of IBD is variable and marked by alternating periods of flare and remission. Even though the use of newer therapeutic targets has been associated with higher rates of mucosal healing, a great proportion of IBD patients remain symptomatic despite effective control of inflammation. These symptoms may include but not limited to abdominal pain, dyspepsia, diarrhea, urgency, fecal incontinence, constipation or bloating. In this setting, commonly there is an overlap with gastrointestinal (GI) motility and absorptive disorders. Early recognition of these conditions greatly improves patient care and may decrease the risk of mistreatment. Therefore, in this review we describe the prevalence, diagnosis and treatment of GI motility and absorptive disorders that commonly affect patients with IBD.

Single needle versus double needle celiac trunk neurolysis in abdominal malignancy pain management: a randomized controlled trial / Neurólise do tronco celíaco com o uso de agulha única versus agulha dupla no manejo da dor abdominal maligna: estudo randômico controlado

Abstract Background: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. Methods: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. Results: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0%; 13.8 ± 1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards Visual Analog Scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, Visual Analog Scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). Conclusion: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.

Resumo Introdução: A neurólise do plexo celíaco guiada por tomografia computadorizada tornou-se uma técnica quase segura para aliviar a dor abdominal maligna. Comparamos a técnica de agulha única mudando o posicionamento do paciente e a técnica de agulha dupla usando a abordagem anterocrural posterior. Métodos: No grupo designado para neurólise celíaca com agulha dupla (n = 17), a técnica de abordagem anterocrural posterior foi utilizada com duas agulhas para injetar 12,5 mL de fenol a 10% de cada lado em decúbito ventral. No grupo designado para neurólise celíaca com agulha única (n = 17), a abordagem anterocrural posterior foi utilizada com uma única agulha para injetar 25 mL de fenol a 10% do lado esquerdo com o paciente em decúbito lateral esquerdo e posteriormente virado para o lado direito. Os parâmetros de monitorização foram a taxa de falha dos bloqueios e a duração do posicionamento dos pacientes, o tempo da técnica, os escores da escala visual analógica, as complicações (hipotensão, diarreia, vômitos, hemorragia, dano neurológico e infecção) e a analgesia de resgate. Resultados: A taxa de falha dos bloqueios e a duração do posicionamento dos pacientes aumentaram significativamente na neurólise celíaca com o uso de agulha dupla vs. agulha única (30,8% vs. 0%,13,8 ± 1,2 vs. 8,9 ± 1; p = 0,046, p ≤ 0,001, respectivamente). Além disso, o tempo da técnica foi significativamente maior na neurólise celíaca com agulha dupla que na neurólise celíaca com agulha única (24,5 ± 5,1 vs. 15,4 ± 1,8; p ≤ 0,001). Não houve diferença significativa em relação aos escores da escala visual analógica: neurólise celíaca com agulha dupla = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) e neurolise celíaca com agulha única = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) após um dia,uma semana, um e três meses, respectivamente. No entanto, os escores da escala visual analógica para cada grupo foram significativamente menores comparados aos valores basais (p ≤ 0,001). Não houve diferença estatisticamente significativa quanto à analgesia de resgate e complicações (p > 0,05). Conclusão: A neurólise celíaca com o uso de agulha única e a alteração do posicionamento do paciente apresenta uma taxa menor de falha do bloqueio, menos tempo de procedimento e menor duração do posicionamento do paciente que o uso de duas agulhas para neurólise celíaca em malignidade abdominal.

[Single needle versus double needle celiac trunk neurolysis in abdominal malignancy pain management: a randomized controlled trial]. / Neurólise do tronco celíaco com o uso de agulha única versus agulha dupla no manejo da dor abdominal maligna: estudo randômico controlado.

BACKGROUND: Computerized tomography-guided celiac plexus neurolysis has become almost a safe technique to alleviate abdominal malignancy pain. We compared the single needle technique with changing patients' position and the double needle technique using posterior anterocrural approach. METHODS: In Double Needles Celiac Neurolysis Group (n = 17), we used two needles posterior anterocrural technique injecting 12.5 mL phenol 10% on each side in prone position. In Single Needle Celiac Neurolysis Group (n = 17), we used single needle posterior anterocrural approach. 25 mL of phenol 10% was injected from left side while patients were in left lateral position then turned to right side. The monitoring parameters were failure block rate and duration of patient positioning, technique time, Visual Analog Scale, complications (hypotension, diarrhea, vomiting, hemorrhage, neurological damage and infection) and rescue analgesia. RESULTS: The failure block rate and duration of patient positioning significantly increased in double needles celiac neurolysis vs. single needle celiac neurolysis (30.8% vs. 0.13.8±1.2 vs. 8.9 ± 1; p = 0.046, p ≤ 0.001 respectively). Also, the technique time increased significantly in double needles celiac neurolysis than single needle celiac neurolysis (24.5 ± 5.1 vs. 15.4 ± 1.8; p ≤ 0.001). No significant differences existed as regards visual analogue scale: double needles celiac neurolysis = 2 (0-5), 2 (0-4), 3 (0-6), 3 (2-6) and single needle celiac neurolysis = 3 (0-5), 2 (0-5), 2 (0-4), 4 (2-6) after 1 day, 1 week, 1 and 3 months respectively. However, visual analogue scale in each group reduced significantly compared with basal values (p ≤ 0.001). There were no statistically significant differences as regards rescue analgesia and complications (p > 0.05). CONCLUSION: Single needle celiac neurolysis with changing patients' position has less failure block rate, less procedure time, shorter duration of patient positioning than double needles celiac neurolysis in abdominal malignancy.

Tumor ovárico del seno endodérmico (Yolk Sac). Dolor abdominal en el puerperio inmediato como síntoma diagnóstico / Endodermal sinus ovarian tumor (Yolk Sac). Abdominal pain in the immediate puerperium as a diagnostic symptom

RESUMEN Los tumores del seno endodérmico ovárico (Yolk Sac), son neoplasias malignas de origen germinal, que se caracterizan por su diferenciación embriológica a partir de estructuras del saco vitelino. Son tumoraciones muy infrecuentes, de crecimiento rápido y que suelen desarrollarse en adolescentes y mujeres jóvenes, en edad reproductiva. Su diagnóstico se basa en la combinación de pruebas de imagen asociado a niveles plasmáticos elevados de marcadores tumorales como la alfafetoproteína. El manejo terapéutico es eminentemente quirúrgico (pudiendo ser conservador en pacientes con deseo genésico no cumplido), asociado a pautas de quimioterapia sistémica combinada con bleomicina, etopósido y platino. Exponemos el caso de una paciente que en el puerperio tardío, presenta un cuadro clínico de dolor, distensión abdominal y fiebre, siendo diagnosticada tras el tratamiento quirúrgico y el estudio histológico posterior, de un tumor del seno endodérmico ovárico.

ABSTRACT Ovarian endodermal sinus tumors (Yolk Sac), are malignant neoplasms of germinal origin, which are characterized by their embryological differentiation from yolk sac structures. These tumors are very infrequent, of rapid growth and tend to develop in adolescents and young women of reproductive age. Its diagnosis is based on the combination of imaging tests associated with high plasma levels of tumor markers such as alpha-fetoprotein. The therapeutic management is eminently surgical (with a more conservative approach reserved for patients still considering later pregnancy), associated with patterns of systemic chemotherapy combined with bleomycin, etoposide and platinum. We present the case of a patient who, in the late puerperium, presents symptoms of pain, abdominal distension and fever, being diagnosed after the surgical treatment and the subsequent histological study of a tumor of the endodermal ovarian sinus.

Gastroenteritis in an adult female revealing hemolytic uremic syndrome: Case report.

Nowadays acute gastroenteritis infection caused by Escherichia coli (E. coli) O157:H7 is frequently associated with hemolytic uremic syndrome (HUS), which usually developed after prodromal diarrhea that is often bloody. The abdominal pain accompanied by failure kidney is a suspicious symptom to develop this disorder. Their pathological characteristic is vascular damage which manifested as arteriolar and capillary thrombosis with abnormalities in the endothelium and vessel walls. The major etiological agent of HUS is enterohemorragic (E coli) strain belonging to serotype O157:H7. The lack of papers about HUS associated to gastroenteritis lead us to report this case for explain the symptoms that are uncommon. Furthermore, this report provides some strategies to suspect and make an early diagnosis, besides treatment approach to improving outcomes and prognosis for patients with this disorder.

A homeopatia na terapia intensiva

Trabalho realizado a partir de três casos clínicos, em que foram abordados pacientes que apresentaram quadro de sepse de foco abdominal ou pulmonar e foram tratados com medicações homeopáticas dentro da unidade de terapia intensiva (UTI). (AU)

Efectividad del masaje en el área abdominal para la reducción de los cólicos del lactante / Effectiveness of massage in the abdominal area to reduce infant colic / Eficácia da massagem na região abdominal para reduzir cólica infantil

ResumenIntroducción. El cólico del lactante es una afección benigna que pueden experimentar los menores de seis meses; no obstante, aunque no pone en peligro su vida, puede convertirse en una experiencia traumática para los padres y la familia, además de resultar muy molesto para el mismo lactante.Método. Para el desarrollo de este trabajo se utilizó la metodología investigativa de práctica de enfermería basada en la evidencia (PEBE), se planteó una pregunta clínica y se realizó búsquedas electrónicas en MEDLINE, SIBDI, Google académico, PubMed, Cochrane Library Plus. Después de establecer los criterios de inclusión y exclusión y análisis crítico, se seleccionó cuatro documentos que respondieran a la pregunta clínica.Resultados. Ningún estudio respondió directamente a la pregunta, sin embargo, varias investigaciones confirman que el masaje reduce las horas de llanto, influye en el estado de ánimo del lactante y promueve un cambio de actitud de los padres ante los eventos benignos de los cólicos del lactante.Conclusión.El cólico del lactante es uno de los principales problemas que enfrentan los padres y los lactantes sanos menores de seis meses, por lo que es una consulta para los profesionales de salud que los atienden. No existe base científica de que el masaje abdominal modifique en algún aspecto orgánico el tracto digestivo, pero sí existe evidencia de cambios en el comportamiento de los lactantes, reducción de las horas de llanto y mejoramiento de las horas de sueño, además mejora la actitud de los padres ante las molestias que los lactantes pueden experimentar durante los periodos de cólicos.

AbstractIntroduction. Infantile colic is a benign condition that may experience less than six months; however, although not life threatening, it can become a traumatic experience for parents and family, as well as being very annoying for the same infant.Method. For the development of this work practice research methodology based on evidence (PEBE) was used nurses, a clinical question was raised and electronic searches of MEDLINE, SIBDI, Google Scholar, PubMed, Cochrane Library Plus. After establishing the criteria for inclusion and exclusion and critical analysis, four documents to answer the clinical question he was selected.Results. No study directly answer the question, however, several studies confirms that massage reduces hours of crying, influences mood infant and promotes a change in attitude of parents to benign events colic infant.Conclusion. Infantile colic is one of the main problems that parents and children six months healthy infants face, so it is a query for health professionals who serve them. There is no scientific basis that abdominal massage alter some organic aspect the digestive tract, but there is evidence of changes in the behavior of infants, reduction of hours of crying and improving sleep, and improves attitude parents to the discomfort that infants may experience during periods of colic.

ResumoIntrodução. Cólica infantil é uma condição benigna que pode experimentar menos de seis meses; No entanto, embora não seja uma ameaça à vida, ela pode se tornar uma experiência traumática para os pais e familiares, bem como sendo muito irritante para a mesma criança.Método. Para o desenvolvimento desta metodologia de pesquisa prática de trabalho com base em evidências (PEBE) foi utilizado enfermeiros, uma questão clínica foi levantada e buscas eletrônicas do MEDLINE, SIBDI, Google Scholar, PubMed, Biblioteca Cochrane Plus. Depois de estabelecer os critérios de inclusão e exclusão e análise crítica, quatro documentos para responder à pergunta clínica ele foi selecionado.Resultados. Nenhum estudo responder directamente à questão, no entanto, vários estudos confirmam que a massagem reduz as horas de choro, influências humor infantil e promove uma mudança de atitude dos pais para eventos cólica benigna infantil.Conclusão. cólica infantil é um dos principais problemas que as crianças os pais e crianças de seis meses saudáveis enfrentam, por isso é uma consulta para profissionais de saúde que os atendem. Não há base científica que a massagem abdominal alterar algum aspecto orgânico do trato digestivo, mas não há evidências de mudanças no comportamento das crianças, redução da jornada de choro e melhorar o sono e melhora a atitude pais para o desconforto que as crianças podem experimentar durante os períodos de cólica.

Efficacy and Safety of Lactobacillus plantarum DSM 9843 (LP299V) in the Prevention of Antibiotic-Associated Gastrointestinal Symptoms in Children-Randomized, Double-Blind, Placebo-Controlled Study.

OBJECTIVES: To determine if Lactobacillus plantarum DSM9843 (LP299V) reduces the frequency of antibiotic-associated loose/watery stools and gastrointestinal symptoms, and can be administered safely to children who are prescribed antibiotics. STUDY DESIGN: We performed a prospective, double-blind, randomized, placebo-controlled, multicenter, parallel-group study in children receiving outpatient antibiotic therapy in primary healthcare settings. The children were given LP299V/placebo during the antibiotic therapy and for 1 week after the end of treatment. The primary outcome measure was the incidence of at least 1 loose/watery stool (type 6 or 7 according to the Bristol Stool Form Scale). Gastrointestinal symptoms (abdominal pain, abdominal distention, vomiting, and flatulence) were followed up until 1 week after the last intake of the study product. RESULTS: A total of 438 children (male: 235, female: 203) aged 1-11 years (mean ± SD: 5.2 ± 2.7) were randomized to receive LP299V (N = 218) or placebo (N = 220). The incidence of loose/watery stools in the 2 study groups (LP299V and placebo) was similar, 39% vs 44.5% respectively (P = .26) as was the mean number of loose/watery stools (3.9 ± 3.5 vs 4.7 ± 6.3; P = .9). Antibiotic-associated diarrhea (defined as ≥3 loose/watery stools/24 hours starting from 2 hours after initiation of antibiotic treatment until the end of the study) occurred in 2.8% of the subjects receiving LP299V compared with 4.1% in the placebo arm (P = .4). The number of children with abdominal symptoms did not differ between the groups. CONCLUSIONS: No beneficial effect of LP299V compared with placebo was observed for the incidence of loose/watery stools, mean number of loose/watery stools, or the incidence of abdominal symptoms. LP299V had a satisfactory safety profile. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01940913.

[Celiac block in paediatric patients using endoscopic ultrasound for management of severe pain due to chronic pancreatitis. Review of the technique in 2 cases]. / Bloqueo celiaco en Pediatría mediante ultrasonido endoscópico para el manejo de dolor por pancreatitis crónica. Revisión de la técnica en 2 casos.

BACKGROUND: Pancreatic diseases such as cancer, idiopathic recurrent pancreatitis, and chronic pancreatitis, can cause pain that is difficult to control. Pain is one of the most debilitating symptoms and demands increasing doses of analgesics and narcotics, as well as the number of hospital admissions, with a direct implication in the costs of medical treatments. OBJECTIVE: To describe the experience with 2 paediatric patients who were subjected to an ultrasound-guided endoscopic celiac ganglion block for difficult pain management, secondary to chronic pancreatitis disease. CLINICAL CASES: The first case concerns a 9-year-old male with a diagnosis of chronic pancreatitis, and the second case is a 12-year-old female who developed episodes of intermittent acute pancreatitis. Both cases suffered from chronic abdominal pain, which was difficult to control with stronger painkillers, such as opioids. The pain decreased after patients were subjected to an ultrasound-guided endoscopic celiac ganglion block. CONCLUSIONS: This technique showed that both patients obtained satisfactory pain relief, with significant improvements in general symptomatology and the stopping of almost all analgesic medication. The authors suggest that celiac ganglion block must be considered, and implemented early before the usual complications, such as a consumption syndrome that is frequent in paediatric patients with chronic pancreatitis.

Abdominal Cerebrospinal Fluid Pseudocyst Diagnosed by Point-of-Care Ultrasound.

Abdominal cerebrospinal fluid pseudocyst is an uncommon complication of ventriculoperitoneal shunt and is seen more commonly in the pediatric population. The diagnosis of an abdominal cerebrospinal fluid pseudocyst is typically made by ultrasonography, which demonstrates a simple or loculated fluid collection in the abdomen. We present a case of abdominal pseudocyst diagnosed by point-of-care ultrasound.