Management of metabolic syndrome in morbidly obese children and adolescents

The main goal in managing metabolic syndrome (MS) in children and adolescents is to prevent Type 2 DM and reduce the risk of future cardiovascular disease. Although frustrating and challenging for both patients and healthcare providers, the best strategy for managing MS is preventing obesity through promotion of lifestyle modifications that include weight reduction, prevention of excessive weight gain and increase physical activity. Different therapeutic options and medications for MS are discussed including side effects of each drug. Medication for MS should be given to children and adolescents only after attempts at lifestyle modification have failed. Medications for MS should be closely monitored for their side effects on patients, and their application supervised only by caregivers familiar with their use.     

Scimitar syndrome treated with pneumonectomy: a case associated with bronchospastic attack

Scimitar syndrome, which involves total or partial anomalous venous drainage of the right lung to the inferior vena cava, is relatively rare and often results in pulmonary hypertension, heart failure and right lung infection. We report here the case of a 1-year-old girl who suffered repeated attacks of bronchospasm after developing pneumonia. She underwent resection of the hypoplastic right lung and showed rapid recovery.     

Early metabolic improvement following bariatric surgery in morbidly obese adolescents

Bariatric surgery results in durable weight loss and improved comorbidities. The objectives of this study were to examine the efficacy of gastric bypass in reducing comorbid burden and improving metabolic status among morbidly obese adolescents. The medical records of 15 gastric bypass patients were retrospectively reviewed. Changes in metabolic markers were determined at baseline, 1 and 2 years post-operatively. Comparative analysis demonstrated significant improvement in weight, BMI, insulin, HbA1C, C-peptide, %B, %S, IR, cholesterol, percentile cholesterol, TG, percentile TG, HDL, percentile HDL, LDL, percentile LDL, and VLDL. Results support bariatric surgery as a treatment for morbidly obese adolescents with comorbidities.     

Transient pituitary dysfunction, empty sella, pseudotumor cerebri in a morbidly obese adolescent

We report a 16-year-old morbidly obese African-American female who developed pseudotumor cerebri, partially empty sella syndrome and transient central hypothyroidism. After reduction of the increased intracranial pressure by lumbar puncture, normalization of the thyroid function occurred. The mechanism of the transient pituitary dysfunction in relation to the pseudotumor cerebri and empty sella is discussed.     

Neuroleptic malignant syndrome in a 4-year-old girl associated with alimemazine

Neuroleptic malignant syndrome (NMS) is a rare but serious disorder caused by antipsychotic medication including phenothiazines. For sedative purposes, increasing doses of alimemazine were administered to a 4-year-old multiple handicapped girl, with cerebral damage of the basal ganglia. She developed extra-pyramidal motor disturbances, an autonomic disorder, lowered consciousness and hyperthermia, characterising NMS. Alimemazine was stopped and dantrolene and supportive measures, including ventilation under sedation and paralysis with midazolam and vecuronium, were started. As clinical symptoms remained unabated, increasing doses of bromocriptine were administered. Two days after maximal bromocriptine dosage, her clinical condition improved and paralysis and ventilation were stopped. Midazolam and bromocriptine could be gradually decreased and suspended during the following months. A few days after bromocriptine cessation NMS recurred and was complicated by a fatal cardiorespiratory arrest. CONCLUSION: caution must be exercised when prescribing alimemazine, especially to children with basal ganglia damage and in the case of inexplicable fever and restlessness, neuroleptic malignant syndrome should be considered. Long-term therapy with bromocriptine combined with dantrolene and midazolam may be a successful medical treatment.     

肥胖儿童代谢综合征代谢紊乱与血清高敏C反应蛋白关系探讨

目的研究对肥胖儿童人群中代谢综合征(MS)与血清高敏C-反应蛋白(hs-CRP)之间的关系,探讨hs-CRP在MS发病机制中的作用及在MS诊断、评价中的可能。方法选取2006年6月至2008年3月在天津医科大学总医院儿科门诊确诊的肥胖儿童109例,根据腰围、血压、血脂及糖耐量指标将患儿分为MS组非MS组,进行人体参数测量并收集临床基本资料,测定hs-CRP、血脂,进行口服糖耐量试验和胰岛素释放试验。对上述资料进行统计学分析。结果血清hs-CRP水平MS组高于非MS组(P<0.05);Sperman相关分析提示hs-CRP水平与体重指数(BMI)、腰围、腰围/身高比值(WHtR)、非酒精性脂肪肝情况、胰岛素抵抗指数(HOMA-IR)及MS组分数呈正相关(P<0.05),与血浆HDL-C水平呈负相关(P<0.05)。回归分析表明WHtR(OR=2.708,P<0.05)、BMI(OR=1.169,P<0.05)及腰围(OR=1.145,P<0.05)为hs-CRP水平的显著影响因素。结论提示慢性炎症反应和胰岛素抵抗可能共同参与MS的发病及进展过程,血清hs-CRP水平可作为预计和评价儿童MS的有效指标之一。     

Presence of metabolic cardiovascular syndrome in obese children

The aim of the present study was to investigate the aggregation of cardiovascular risk factors (hyperinsulinaemia, impaired glucose tolerance, dyslipidaemia, and hypertension) in 180 (77 female, 103 male) obese and 239 control children. Blood glucose, serum insulin and lipid levels were determined from blood samples taken after an overnight fast. Oral glucose tolerance tests were performed and blood glucose concentrations were monitored. The body mass index, body fat (on the basis of skinfold measurements), lean body mass and waist/hip ratio were calculated and blood pressure was measured five times in all subjects. It was shown that only 14.4% of obese children were free from any risk factors, in contrast to 79.1% of the control children. Four risk factors (metabolic cardiovascular syndrome) were found in 8.9% of the obese children (8.7% in males and 9.l % in females) while none could be detected in controls. Considerable differences were also detected in the prevalence of one, two or three risk factors between control and obese children. Patients with the metabolic cardiovascular syndrome could not be characterized by any of the investigated anthropometric characteristics, but the duration of obesity was significantly longer in these children. Conclusion Potential risk factors for cardiovascular diseases already tend to cluster in childhood and they are strongly associated with obesity. Our observations suggest that the development of the metabolic cardiovascular syndrome has its origin in childhood. Received: 15 September 1998 / Accepted: 20 July 1999     

Transient gall bladder dilatation associated with hypokalaemia in a patient with Bartter syndrome

A 5.5-month-old male infant with hypokalaemia and gall bladder dilatations is reported. The child was shown to have Bartter syndrome. After oral treatment with potassium and indomethacin, serum potassium levels became low normal and the gall bladder enlargement resolved. This entity should be included in the clinical spectrum of neuromuscular disturbances resulting from hypokalaemia and should be considered in a hypokalaemic infant with a right-sided abdominal mass.     

Hyperbilirubinemia associated with a cystic abdominal mass in a 6-week-old girl: case report

Abdominal cysts in girls are frequently observed by abdominal ultrasound (US) and are usually ovarian. In this case a cystic structure located in the right abdomen was seen in a female newborn without symptoms and was initially described as a possible ovarian cyst. Frequent US examinations showed an increase in volume and diameter, and temporary, recurring episodes of hyperbilirubinemia were observed. The US scans showed no relationship to the biliary tree. During a diagnostic laparoscopy, a cystic structure attached to the pyloric region was seen. A laparotomy revealed a cystic duplication of the stomach, which could be resected completely. The finding is discussed emphasizing the importance of clinical findings and diagnostic methods in the diagnosis and management of abdominal cystic masses in females. Accepted: 25 June 1997     

Pregnancy outcomes in women after bariatric surgery compared with obese and morbidly obese controls

Pre-pregnancy obesity has become an increasing problem among women of reproductive age, and has been associated with increased rates of gestational diabetes (due to insulin resistance), pre-eclampsia, as well as adverse perinatal outcomes and co-morbidities in case of pregnancy.In this retrospective study, the authors investigate the rates of gestational diabetes and hypertensive disorder of pregnancy in 70 women who had a singleton pregnancy after bariatric surgery. Four pregnant control

Comments

When reading the current literature on pregnancy after bariatric surgery, one should keep in mind this literature is limited primarily by (1) small numbers, reported in retrospective studies and thus lack of power to detect significant differences in outcomes, (2) heterogeneous control groups, and (3) sources of bias (e.g. surveys conducted on patients whose pregnancies occurred several years prior, different types of bariatric surgery). These methodological weaknesses may lead to an