Comparison of soy-based formulas with lactose and with sucrose in the treatment of acute diarrhea in infants.

OBJECTIVE: To evaluate the effect of feeding infants a soy-based formula with lactose compared with a soy-based formula with sucrose during an acute diarrheal episode. PARTICIPANTS AND METHODS: Two hundred boys, aged 3 to 18 months, who were admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive a soy-based formula with lactose or sucrose after initial rehydration. Intake and output (stool, urine, and vomit) were measured and recorded every 3 hours until diarrhea resolved. RESULTS: The stool output during the first 24 hours of maintenance therapy, the total stool output during maintenance therapy, and the stool output during the entire illness (measured in grams per kilograms) were significantly lower among patients who received the soy-based formula with sucrose (P<.05, P<.001, and P<.001, respectively) than among patients who received the soy-based formula with lactose. The duration of diarrhea was significantly shorter among patients who received the soy-based formula with sucrose (P<.001). The relative risk of being withdrawn from the study increased to 1.95 (95% confidence interval, 0.65-9.2) and the relative risk of recurrence of dehydration after feeding was initiated increased significantly to 3.49 (95% confidence interval, 1.1-9.6; P<.01) in the group receiving the soy-based formula with lactose. CONCLUSION: During diarrheal episodes, feeding infants a soy-based formula with sucrose has a better outcome (lower stool output, shorter duration of diarrhea, and lower failure rates) than feeding infants a soy-based formula with lactose.

Subcarinal foregut cysts. A unique clinical problem.

BACKGROUND: To evaluate the risks associated with a subcarinal foregut cyst in a fixed mediastinal space. DESIGN: Between January 1, 1986, and August 1, 1997, 8 patients who had subcarinal cysts and who underwent surgical intervention were identified. These results were analyzed to identify associated symptoms and results of surgical intervention. Mean duration of follow-up was 37.3+/-2.2 months and was 100% complete. PATIENTS: Of the eight patients, three were men. Mean age was 45.6+/-15.6 years (range 24-66). All patients were symptomatic. Six patient suffered respiratory distress. Four patients complained of chest pain. Preoperatively, all patients underwent routine chest radiography. Six patients underwent computed chest tomography (CT); 4 patients had magnetic resonance imagery (MRI) of the chest. Cardiac echocardiography was performed on 4 patients and esophagogastroduodenoscopy (EGD) with or without esophageal ultrasound (EUS) was done in 4. Of 7 patients who underwent bronchoscopy, 6 patients demonstrated extrinsic airway compression. The remaining patient showed fistulous communication. INTERVENTION: Cyst dimensions ranged from 7.33+/-1 cm (mean+/-SD). Total resection of the cyst was accomplished in 6 patients. One patient with fistulization underwent right main bronchial sleeve resection. Histopathology revealed inflammation of the cyst in 2 cases and calcification of the cyst wall in 1. Fluid from one cyst grew gram positive cocci. RESULTS: Length of hospital stay ranged from 10.9+/-4.4 days. There were no mortalities. Morbidity included prolonged ventilation (1), pulmonary embolism (1) and left recurrent laryngeal palsy (1). CONCLUSIONS: Our results corroborate the need for surgical excision of subcarinal subtype cysts to prevent the development of mediastinal compression and other cyst-related complications.

Surgical correction for sinus of Valsalva aneurysm.

BACKGROUND: To evaluate the efficacy of surgical correction of sinuses of Valsalva aneurysms, 24 patients operated on from 1974-1994 were reviewed. Mean age was 42.2+/-16.7 years; 17 were males. METHODS: Right coronary sinus was affected in 13 patients and noncoronary sinus in 8. Intracardiac fistula was detected in 16 patients: into the right atrium in 8; right ventricle in 5; left ventricle in 2; and left atrium in 1. Repair was performed via an aortic approach in 11 patients and a combined aortic and intracardiac approach in 13 patients. Suture closure of the fistula was via the aortic side in 10 cases and the intracardiac side in 6. Ten patients had patch closure via the aortic side. RESULTS: Follow-up was 92% complete at a mean of 8.4 years with 3 late cardiac and 1 noncardiac deaths. Eighty-eight percent of patients are in New York Heart Association functional class I or II; none underwent reoperation. CONCLUSIONS: Sinuses of Valsalva aneurysm repair have low operative mortality and morbidity risks with excellent early and late results. Surgical approach is dependent upon the presenting pathology.

Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial.

BACKGROUND: The probiotic Lactobacillus GG is effective in promoting a more rapid recovery of acute, watery diarrhea in children with rotavirus enteritis. Very limited information is available, however, on the potential role of such agents in non-rotaviral diarrheal episodes. Furthermore, no evidence is available concerning the efficacy of Lactobacillus GG administered in the oral rehydration solution during oral rehydration therapy. A multicenter trial was conducted to evaluate the efficacy of Lactobacillus GG administered in the oral rehydration solution to patients with acute-onset diarrhea of all causes. METHODS: Children 1 month to 3 years of age with acute-onset diarrhea were enrolled in a double-blind, placebo-controlled investigation. Patients were randomly allocated to group A, receiving oral rehydration solution plus placebo, or group B, receiving the same preparation but with a live preparation of Lactobacillus GG (at least 10(10) CFU/250 ml). After rehydration in the first 4 to 6 hours, patients were offered their usual feedings plus free access to the same solution until diarrhea stopped. RESULTS: One hundred forty children were enrolled in group A, and 147 in group B. There were no differences at admission between the groups in age, sex, previous types of feeding, previous duration of diarrhea, use of antibiotics, weight, height, weight-height percentile, prevalence of fever, overall status, degree of dehydration, and percentage of in- versus outpatients. Duration of diarrhea after enrollment was 71.9 +/- 35.8 hours in group A versus 58.3 +/- 27.6 hours in group B (mean +/- SD; P = 0.03). In rotavirus-positive children, diarrhea lasted 76.6 +/- 41.6 hours in group A versus 56.2 +/- 16.9 hours in groups B (P < 0.008). Diarrhea lasted longer than 7 days in 10.7% of group A versus 2.7% of group B patients (P < 0.01). Hospital stays were significantly shorter in group B than in group A. CONCLUSIONS: Administering oral rehydration solution containing Lactobacillus GG to children with acute diarrhea is safe and results in shorter duration of diarrhea, less chance of a protracted course, and faster discharge from the hospital.