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1.
Caffarelli C Coscia A Baldi F Borghi A Capra L Cazzato S Migliozzi L Pecorari L Valenti A Cavagni G 《European journal of pediatrics》2007,166(12):1245-1252
Allergy is believed to play a role in the pathogenesis of irritable bowel syndrome (IBS) and constipation. We investigated
whether allergic patients are more prone to constipation or IBS. In a multicenter study, two groups of outpatient children
aged 3–13 years were included. In group 1, children with allergic symptoms were enrolled. Group 2 consisted of nonallergic
children. In both groups, the assessment of IBS and constipation was carried out using a questionnaire based on the Rome criteria
for functional gastrointestinal disorders. All children were examined and underwent skin prick tests (SPT) to foods and aeroallergens.
The allergic group (n = 196) and controls (n = 127) were comparable with respect to sex, age, and anthropometric parameters. IBS was found in 6.6% of the allergic children
and in 6.3% of the controls (p = 0.581). The frequency of constipation was similar in the two groups. In allergic children, positive SPTs to food and self-reported
reactions to food were associated with IBS. Our results show that evaluation of constipation comorbidity is not required in
allergic children. In allergic children with positive SPT to foods attention may be paid to IBS symptoms. 相似文献
2.
Standard medical therapies do not alter colonic transit time in children with treatment-resistant slow-transit constipation 总被引:1,自引:0,他引:1
Melanie C. C. Clarke Janet W. Chase Susie Gibb Anthony G. Catto-Smith John M. Hutson Bridget R. Southwell 《Pediatric surgery international》2009,25(6):473-478
Background Slow transit constipation (STC) is a form of chronic constipation characterised by prolonged passage of faecal matter through
the colon. It is diagnosed by demonstrating delayed colonic transit on gastrointestinal transit studies. Traditionally, radio-opaque
marker studies are performed. Recently, radioisotope nuclear transit studies (NTS) have been used in our centre to assess
gastrointestinal transit time. This study aimed to evaluate if there are changes in colonic transit in STC children resistant
to standard medical treatment over a prolonged period.
Methods Children with STC resistant to standard medical therapy for ≥2 years who had undergone two separate NTS to assess their colonic
transit (where the first study had identified slow colonic transit without anorectal retention) were identified after ethical
approval. The geometric centre (GC) of radioisotope activity at 6, 24, 30 and 48 h was compared in the two transit studies
to determine if changes occurred.
Results Seven children (4 males) with proven STC resistant to standard medical therapy and two transit studies performed at different
times were identified. Mean age was 7.0 years (5.4–10.8 years) at first study, and 11.4 years (9.7–14.2 years) at second study,
with a mean of 4.4 years (1–8.5 years) between studies. There was no significant difference in colonic transit at any timepoint
in the two tests (paired t test).
Conclusions We conclude that nuclear transit studies are reproducible in assessing slow colonic transit in children with treatment-resistant
STC and demonstrate that conventional medical treatment over many years has no effect on underlying colonic motility. 相似文献
3.
Clinical application of wireless capsule endoscopy in pediatric patients for suspected small bowel diseases 总被引:1,自引:0,他引:1
Capsule endoscopy (CE) has been demonstrated to be safe and well tolerated in adults with suspicion of small intestinal diseases
with negative results of gastroscopy and colonoscopy. However, its value in pediatric patients has not yet been well studied.
This study aimed to evaluate the results and safety of CE in pediatric patients with suspicion of small bowel disorders. There
were 16 consecutive children and adolescents (12 boys, 4 girls) and 15 adults (9 men, 6 women) referred to us for suspected
small bowel diseases from August 2002 to September 2005. Among the pediatrics, six patients were less than 10 years old. Technique
for capsule placement, gastric transit time, small bowel transit time, excretion time of capsule endoscopy, capsule findings,
and complications were recorded. All 16 pediatric patients described that the capsule was easy to swallow except for three
children. Finally we delivered the capsule under gastroscopy with overtube for these three children. No capsule retention
occurred during our study. Median recording time was 7 h 44 min (range 6 h 51 min–9 h 11 min). Median gastric transit time
was 83.5 min (range 4–296 min). Median small bowel transit time was 270 min (range 142–484 min).Median excretion time of capsule
was 33.9 h (range 12–96 h). There was no significant difference in excretion time of capsule, gastric transit time and small
bowel transit time between pediatric patients and adult patients (P > 0.05). CE was positive in 12 patients, including Crohn’s disease (4), hemangioma (2), angiodysplasia (2), Meckel diverticulum
(1), polyp (1), aphthous ulcer in ascending colon (1), and cobblestone appearance of ileal mucosa. CE has been performed safely
in a small series of pediatric patients after ingestion or endoscopic placement of the capsule. The high yield of abnormal
findings was comparable to those of adult patients.
Supported by Shanghai Leading Academic Discipline Project (Project number: Y0205). 相似文献
4.
Gastrointestinal transit time, frequency of defecation, and anorectal manometry in healthy and constipated children 总被引:1,自引:0,他引:1
E Corazziari S Cucchiara A Staiano G Romaniello O Tamburrini A Torsoli S Auricchio 《The Journal of pediatrics》1985,106(3):379-382
Total gastrointestinal transit time (TGITT), frequency of defecation, and anorectal manometry were evaluated in 63 pediatric patients referred for chronic nonorganic constipation; in 39, segmental transit times of the right and left colon and rectum were also measured. TGITT was significantly longer in chronically constipated children than in matched normal controls. Although bowel frequency was highly significantly correlated with TGITT in patients with prolonged transit time, not all children with prolonged TGITT had reduced bowel frequency. Moreover, not all children with constipation had prolonged TGITT. In children with idiopathic chronic constipation, slowing of intestinal transit occurred most frequently at the level of the distal colon and rectum. Anorectal motility variables were not significantly different in children with functional chronic constipation and in normal children. Maximal resting and pressure and mean intrarectal distending volume causing threshold inhibition in constipated patients did not significantly differ from the control values. Therefore, anorectal manometry did not detect relevant motor abnormalities in constipated children. 相似文献
5.
Bridget R. Southwell Melanie C. C. Clarke Jonathan Sutcliffe John M. Hutson 《Pediatric surgery international》2009,25(7):559-572
The sitz or plastic marker study for colonic transit has been around for many years. It is applicable where an X-ray machine
exists, is widely used and is accepted as the gold standard for diagnosing constipation. Recently, radiopharmaceutical methods
have been developed. The theme of this review is their possible roles in the assessment of paediatric bowel motility disorders
in patients presenting to paediatric surgeons. This review presents data on total and segmental transit in normal adults and
children and comparing the two techniques in adults. Reliability and reproducibility are presented. Normative data for colonic
transit in adults and children are discussed and parameters for assessing abnormal transit are reviewed. Normal colonic transit
takes 20–56 h. Plastic marker studies are more readily accessible, but the assessment may be misleading with current methods.
Plastic markers show faster transit than scintigraphy. It is difficult to compare the two techniques because methods of reporting
are different. Using scintigraphy, repeatability is good. Separation of normal from slow transit in the ascending colon is
apparent at 24 and 48 h, but the determination of transit through the distal colon/rectum in adults may require studies of
more than 7 days. In conclusion, plastic marker studies and scintigraphy show similar transit rates in young adults and children.
However, scintigraphy has advantages of allowing transit through the stomach and small intestine to be measured and has proved
useful in the diagnostic workup of children with intractable constipation. 相似文献
6.
Biopsychosocial treatment of defecation problems in children with anal atresia: a retrospective study 总被引:2,自引:0,他引:2
van Kuyk EM Brugman-Boezeman AT Wissink-Essink M Severijnen RS Festen C Bleijenberg G 《Pediatric surgery international》2000,16(5-6):317-321
In a retrospective study, we examined whether multidisciplinary treatment based on a biopsychosocial approach and carried
out by a pediatric surgeon, a child psychologist, and a pediatric physiotherapist is successful in reducing defecation problems
(incontinence and/or constipation) in children with operated anal atresia (AA) (mean age 6.9 ± 4.01 years). A second question
was whether this treatment is successful in young children aged 2–5 years. The multidisciplinary approach consisted of standard
medical treatment and a behavioral program to teach children and their parents adequate defecation behavior including an adequate
straining technique. Forty-three children aged 2–16 years were included: 27 boys and 16 girls with AA, of whom 26 had high
or intermediate and 17 low AA. Besides continence and constipation, defecation behavior and straining technique were evaluated.
The children improved significantly during treatment in all aspects of defecation. No differences in effect of treatment were
found between young children (2–5 years) and older ones, so this treatment seems to be equally effective in both age groups.
This study demonstrates that both somatic and behavioral factors contribute to the persistence of chronic defecation problems.
It is concluded that treatment of these problems in patients with operated AA should include behavioral modification techniques.
Accepted: 1 February 2000 相似文献
7.
Serum transferrin receptor in children and adolescents with inflammatory bowel disease 总被引:5,自引:0,他引:5
Revel-Vilk S Tamary H Broide E Zoldan M Dinari G Zahavi I Yaniv I Shamir R 《European journal of pediatrics》2000,159(8):585-589
Iron studies are difficult to interpret in patients with chronic inflammatory states such as inflammatory bowel disease (IBD).
Serum transferrin receptor (TfR) has been reported to be a reliable tool for the diagnosis of iron deficiency in adults. Our
aim was to evaluate the role of serum TfR in diagnosing iron deficiency in children and adolescents with IBD. A total of 63
consecutive patients with IBD, aged 9 to 22 years (median 15 years), were tested for serum haemoglobin level, mean corpuscular
volume (MCV), and serum iron, transferrin, ferritin and serum TfR levels. Those found to be anaemic were compared with seven
age-matched subjects with iron deficiency anaemia (IDA) and 24 age-matched children without signs of anaemia or inflammation.
Of the 63 patients with IBD, 26 had anaemia. Based on ferritin levels and MCV indices, anaemia was classified as IDA in 11
patients and as anaemia of chronic disease (ACD) in 15 patients. Mean serum TfR level in normal controls was 3.5 mg/l (range
1.2–8.2 mg/l). Mean (±SD) serum TfR levels were significantly lower in the IBD patients with ACD (5.3 ± 2.3 mg/l) than in
the IBD patients with IDA (8.2 ± 3.1 mg/l) (P < 0.05). Serum TfR levels above 5 mg/l identified 10/11 IBD patients with IDA. The calculated TfR/ferritin ratio was 84 (range
17–367) for controls and 133 (range 6.4–1840) for IBD patients. A cut-off level of 350 (91% sensitivity, 100% specificity,
100% positive predictive value, 98% negative predictive value) was established for the diagnosis of IDA in IBD.
Conclusion The results suggest that serum transferrin receptor is a useful parameter for the diagnosis of iron deficiency in inflammatory
bowel disease, in particular, the transferrin receptor/ferritin ratio with a cut-off level ≥350.
Received: 1 June 1999 / Accepted: 16 February 2000 相似文献
8.
Dr. M. Cla?en 《Monatsschrift für Kinderheilkunde》2011,159(12):1206-1212
Irritable bowel syndrome (IBS) represents the most prevalent manifestation of functional gastrointestinal disorders in children and adolescents. It is characterized by recurrent abdominal pain or discomfort without evidence for organic disorders associated with defecation or alterations in stool frequency or stool form (diarrhea or constipation). The etiology of irritable bowel syndrome is multifactorial and complex. Genetic and familial factors together with stressful early life events and gastrointestinal infections may lead to mucosal inflammation, disturbances of intestinal motility and permeability. The diagnostic process consists of careful history and physical examination and simple investigations. Invasive procedures should be avoided whenever possible. Treatment of children and adolescents with IBS should be based on the biopsychosocial model of functional gastrointestinal disorders. Development of a positive relationship between pediatrician, child and parents is part of the therapeutic process. Cognitive-behavioral training as part of a multidisciplinary psychosocial intervention is recommended. Pharmacotherapy (probiotics, peppermint oil and macrogol) should be given only in selected cases. 相似文献
9.
Intestinal D-fructose absorption in 31 children was investigated using measurements of breath hydrogen. Twenty five children had no abdominal symptoms and six had functional bowel disorders. After ingestion of fructose (2 g/kg bodyweight), 22 children (71%) showed a breath hydrogen increase of more than 10 ppm over basal values, indicating incomplete absorption: the increase averaged 53 ppm, range 12 to 250 ppm. Four of these children experienced abdominal symptoms. Three of the six children with bowel disorders showed incomplete absorption. Seven children were tested again with an equal amount of glucose, and in three of them also of galactose, added to the fructose. The mean maximum breath hydrogen increases were 5 and 10 ppm, respectively, compared with 103 ppm after fructose alone. In one boy several tests were performed with various sugars; fructose was the only sugar incompletely absorbed, and the effect of glucose on fructose absorption was shown to be dependent on the amount added. It is concluded that children have a limited absorptive capacity for fructose. We speculate that the enhancing effect of glucose and galactose on fructose absorption may be due to activation of the fructose carrier. Apple juice in particular contains fructose in excess of glucose and could lead to abdominal symptoms in susceptible children. 相似文献
10.
Juan Antonio Ortega-García Kristina Rodriguez Marta Calatayud Marlene Martin Dinoraz Vélez Vicenta Devesa Mari Carmen Sánchez-Alarcon Alberto Manuel Torres Cantero Consuelo Galindo-Cascales Juana María Gil-Vázquez Miguel Felipe Sánchez-Sauco Manuel Sánchez-Solís Blas Alfonso-Marsilla Fernando Romero-Braquehais 《European journal of pediatrics》2009,168(9):1075-1080
Methylmercury (MeHg) is a bioaccumulable toxin in the trophic chain and a powerful neurotoxin during fetal and child development.
Consumption of contaminated fish and shellfish is a principal environmental source of MeHg exposure. This study was designed
to assess the Hg and estimated MeHg intake in vulnerable groups of the Murcia region, a Mediterranean part of Spain, compared
with international regulations. A validated food frequency questionnaire was used to assess seafood consumptions in 320 children
younger than 10 years, 301 women of childbearing age, and 537 pregnant women. Hg concentrations were measured in the most
consumed fish products by cold vapor generation–atomic fluorescence spectrometry. The weekly intake of MeHg (μg/kg bw/week)
was 2.60 (95% CI = 2.10–3.10) in children 1–5 years, 2.65 (95% CI = 2.26–3.03) in children 6–10 years, 0.98 (95% CI = 0.89–1.07)
in women of childbearing age, and 0.88 (95% CI = 0.81–0.95) in pregnant women. The main exposure to MeHg, especially in young
children, is related to intake of bluefin tuna and swordfish. Fifty-four percent of children aged 1–10 years, 10% of pregnant
women, and 15% of women of childbearing age exceed the Joint Expert Committee on Food Additives provisional tolerable weekly
intake of MeHg. In the Murcia region, where fish is a central component of the diet, the focus should be on educating vulnerable
populations to reorient fish consumption in order to lower the amount of Hg incorporated with the diet as well as to reduce
Hg emissions into the environment. 相似文献
11.
von Linstow ML Høgh M Nordbø SA Eugen-Olsen J Koch A Høgh B 《European journal of pediatrics》2008,167(10):1125-1133
Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are important respiratory pathogens with similar symptomatology.
The aim of this prospective birth cohort study was to identify risk factors for an hMPV or RSV infection during the first
year of life in unselected healthy children. We followed 217 children from birth to 1 year of age. Nasal swabs and symptom
diaries were collected monthly. Anti-hMPV and anti-RSV IgG antibodies by age 1 year were detected by ELISA, and nasal swabs
were analysed for hMPV and RSV by RT-PCR. Logistic regression was used for risk factor analysis. Anti-hMPV IgG was found in
38 children (17.5%), and anti-RSV IgG in 172 children (79%). Risk factors for being anti-hMPV IgG-positive were: (1) being
born in the spring (OR = 2.36; 95% CI:1.06–5.27), and (2) having older siblings (OR = 3.82; 95% CI:1.75–8.34). Risk factors
for being anti-RSV IgG-positive were: (1) gestational age <38 weeks (OR = 3.39; 95% CI:1.42–8.05), (2) increasing paternal
age (OR = 1.85 per 5 yrs; 95% CI:1.28–2.68), and (3) wall-to-wall carpeting (OR = 3.15; 95% CI:1.29–7.68). Being born in the
spring was associated with decreased odds of being anti-RSV IgG-positive (OR = 0.27, 95% CI:0.09–0.85). Risk factors for RSV
hospitalisation (n = 11) were: (1) older siblings (OR = 4.49; 95% CI: 1.08–18.73) and (2) smoking in the household (OR = 5.06; 95% CI: 1.36–18.76).
Exclusive breastfeeding for the first 14 days of life protected against hospitalisation (OR = 0.21; 95% CI:0.06–0.79). In
conclusion, this study identifies risk factors for mild and asymptomatic hMPV infections in infancy. 相似文献
12.
OBJECTIVE: To determine whether cisapride is effective in the treatment of children with constipation. STUDY DESIGN: Double-blind, placebo-controlled study in which children with chronic constipation were randomly assigned to treatment with cisapride or placebo for 12 weeks. RESULTS: Forty children were enrolled, and 36 completed the therapy. Treatment successes occurred in 13 of 17 (76%) subjects in the cisapride group and 8 of 19 (37%) subjects in the placebo group (P <.03). The odds ratio for response after cisapride administration was 8.2 times higher (95% CI 1.3 to 49.4). During cisapride therapy, there was a significant improvement in number of spontaneous bowel movements per week (from 0.9 +/- 0.1 to 4.1 +/- 1.1), and there was a significant decrease in number of fecal soiling episodes per day (1.8 +/- 0.5 to 0.08 +/- 0.4), percent with encopresis (82% vs 23%), number of laxative doses per week (from 10.3 +/- 2.6 to 0.8 +/- 0.6), percent using laxatives (77% to 24%), and total gastrointestinal transit time (from 115.0 +/- 3.7 hours to 77.0 +/- 11.1 hours). With placebo, there were no significant changes in the number of spontaneous bowel movements (from 1.0 +/- 0.8 to 2.2 +/- 0.6), percent with encopresis (74% vs 47%), or total gastrointestinal transit time (from 112.5 +/- 4.9 hours to 95.4 +/- 9.8 hours); but there was a significant decrease in number of fecal soiling episodes per day (from 1.3 +/- 0.4 to 0.4 +/- 0.2) and number of laxative doses used per week (from 11.5 +/- 2.9 to 2.05 +/- 0.7). The final number of spontaneous bowel movements, fecal soiling episodes, laxatives used, or percent patients with encopresis was not different when patients receiving cisapride were compared with those receiving placebo. CONCLUSION: Cisapride was effective in the treatment of children with constipation. 相似文献
13.
Sencan A Mir E Karaca I Akçora B Sencan A Ozer E 《Pediatric surgery international》2000,16(8):554-558
When benzalkonium chloride solution (BACs) is locally applied, to the serosal surface of the intestine, it causes intrinsic
denervation (ID) of the myenteric plexus (MP), changes intestinal morphology, and slows intestinal passage by prolonging small-bowel
transit time. These effects of ID suggest that chemically-induced bowel denervation may be useful in the treatment of short-bowel
syndrome (SBS). How ID affects intestinal morphology in rats with SBS has not previously been investigated. A 75%–80% mid-small-bowel
resection was performed in 20 rats with mean body weight 247 ± 30 g. The proximal and distal 2 cm of the resected bowel were
examined histologically. After intestinal continuity was maintained by end-to-end anastomosis, a 2-cm jejunal segment was
marked with silk sutures to form the test segment. BACs 0.1% was applied to 10 of the 20 test segments according to the modified
Fox method, resulting in MP destruction (G1). Saline solution was applied to the other 10 test segments to form the control
group (G2). Three months later, the rats were killed and the jejunal, ileal, and test segments were evaluated morphologically.
Results were expressed as mean ± standard deviation. The Wilcoxon parametric test was performed to compare the groups during
the operation and after death, while the Mann–Whitney U-test was used to compare the data in G1 and G2. No intestinal obstruction was observed in either group. In G1, the body weight
increased by 19.1% and the total small-intestinal lengthening was 62.2% (P < 0.05). In the test segment of G1, 75% of the ganglia in the MP were destroyed and villus height, crypt depth, intestinal
muscle thickness, number of enterocytes, and villus density increased compared to G2. In the ileal segments of G1, there was
an increase of 28.8% in intestinal diameter, 14% in muscle thickness, and 15% in villus density (P < 0.05). No change was observed in the untreated jejunal segments of G1 and G2. Thus, ID of the MP after segmental BACs application
of the jejunal level: (1) does not cause intestinal obstruction after 3 months; (2) the increase in bowel diameter in the
test and ileal segments increases the absorptive surface of the mucosa; (3) the morphologic changes in the test and ileal
segments verify an increase in intestinal adaptation; and (4) BACs application in rats with SBS is an easy procedure with
no morbidity or mortality, and can be used to increase intestinal adaptation in rats with SBS.
Accepted: 1 February 2000 相似文献
14.
J. B. Hennermann J. Herwig W. März F. Asskali H. J. Böhles 《European journal of pediatrics》1998,157(11):912-918
In 71 children with familial hypercholesterolaemia the effect of dietary and/or medical treatment was evaluated. Initial
total cholesterol and low density lipoprotein (LDL)-cholesterol levels were significantly lower in children who were consecutively
treated by diet (Step-One-Diet) than in those who received additional medication. By dietary treatment, the median total cholesterol
level (236.5 mg/dl; range 210–510 mg/dl) was reduced by 7.4% and the median LDL-cholesterol level (162 mg/dl; range 126–423 mg/dl)
by 9.9%. By dietary and medical therapy, the median total cholesterol level (330 mg/dl; range 270–424 mg/dl) was reduced by
29.7% and the median LDL-cholesterol level (263 mg/dl; 192–333 mg/dl) by 25.9%. High density lipoprotein (HDL)-cholesterol
and HDL 3 remained unchanged. HDL 2 showed a significant decrease of 15.6% up to 27 mg/dl (13–42 mg/dl) on medical treatment.
Apolipoprotein A I levels did not change during therapy. Initial apolipoprotein B levels were significantly higher in children
who were treated by diet and medication and were reduced by 28.9% by combined therapy. In 28 patients (39.4%) an excess of
lipoprotein (a) was detected. Regarding the apolipoprotein E phenotype, 32.2% of the patients carried the risk gene ɛ4 in
a hetero- or homozygous form.
Conclusion Early dietary and/or medical treatment in hypercholesterolaemic children significantly ameliorates the lipoprotein status.
The pretherapy lipoprotein status seems to prognosticate the effectiveness of therapy.
Received: 16 April 1997 / Accepted in revised form: 27 May 1998 相似文献
15.
J. H. Hockstra 《European journal of pediatrics》1995,154(5):362-364
Clear fluids high in fructose (e.g., apple juice) have been incriminated for symptoms of chronic non-specific diarrhoea (CNSD), in particular in children 1–4 years of age. H2 breath tests were performed, after ingestion of fructose (1 g/kg), in 15 patients referred with CNSD and 35 controls. All 15 CNSD children (100%) had breath peak H2 of 20 ppm versus 49% of the 35 controls (P=0.0005). Median peak H2 in CNSD (90 ppm, range 31–136) was significantly higher than in controls (20 ppm, range 1–139) (P<0.001). Orocoecal transit time in children with positive tests was similar in both groups. Similary, median H2 increases during the test period had the same distribution. We demonstrated fructose malabsorption in CNSD, but found a great overlap with the control group. Our results strongly discourage the use of fructose breath H2 tests in children suspected of CNSD. A positive test has no diagnostic value and a negative test has no clinical implications.Conclusion For clinical practice, we suggest a dietary history and a trial of appropriate measures in infants with chronic nonspecific diarrhoea, instead of performing the fructose H2 breath test. 相似文献
16.
Amae S Hayashi J Funakosi S Kamiyama T Yoshida S Ueno T Matsuoka H Hayashi Y 《Pediatric surgery international》2008,24(3):293-298
Our purpose was to clarify factors that influence the level of depression of Japanese children with anorectal malformations
(ARM). The subjects comprised 66 children with ARM, aged 0–16 years, and their mothers. Patients were divided into three groups
(Group 1: aged 0–5 years, Group 2: 6–11 years, and Group 3: 12–16 years). The level of depression of the children aged 6–16 years
was investigated by Kovac’s children’s depression inventory (CDI). The psychological status of their mothers was assessed
by Spielberger’s state-trait anxiety index (STAI) and Zung’s self-rating depression scale (SDS). The classification of ARM
and the clinical condition were also investigated. Defecation scores were assigned for the degree of bowel dysfunction. The
level of depression in the patients was more marked in Group 3 than in Group 2 according to the CDI score. Significant correlations
between the CDI score of the child and the STAI-1, STAI-2 and SDS scores of the mother were observed in Group 2, but not in
Group 3. In Group 2, the STAI-1 score of the mothers was significantly influenced by the degree of bowel dysfunction in her
child. In Group 3, the CDI score was significantly correlated with the constipation score. This study revealed that bowel
dysfunction is the important factor that influences the level of depression of the children with ARM. In the period of childhood
during which the child attends primary school, bowel dysfunction indirectly influences the level of depression of children
through the psychological status of mothers. However, bowel dysfunction directly influences the level of depression of children
in adolescent patients. 相似文献
17.
《Journal of pediatric urology》2014,10(6):1111-1116
PurposeTo evaluate the types of constipation according to colonic transit time in chronically constipated children with dysfunctional voiding (bowel bladder dysfunction, BBD group) and to compare the results with transit type in children with chronic functional constipation without urinary symptoms (constipation group) and children with normal bowel habits, but with lower urinary tract symptoms (control group).Patients and methodsOne-hundred and one children were included and their medical histories were obtained. The BBD group kept a voiding diary, and underwent urinalyses and urine culture, ultrasound examination of bladder and kidneys and uroflowmetry with pelvic floor electromyography. Radionuclear transit scintigraphy was performed in all children according to a standardized protocol. Patients were categorized as having either slow-transit (ST), functional fecal retention (FFR) or normal transit.ResultsFFR was diagnosed in 31 out of 38 children with BBD, and 34 out of 43 children in the constipation group. ST was found in seven children with BBD, compared with nine children in the constipation group. The control group children demonstrated normal colonic transit. Urgency, daily urinary incontinence and nocturnal enuresis were noted only in children with FFR. Both children with ST constipation and FFR complained of difficulties during voiding, voiding postponement and urinary tract infections.ConclusionsFFR is the most common form of constipation in children with dysfunctional voiding. However, some children might suffer from ST constipation. Differentiation between these two types of constipation is clinically significant because they require different treatment. Future studies with larger numbers of patients are needed to confirm the noted differences in urological symptoms in these two groups of constipated children.. 相似文献
18.
Jonathan R. Sutcliffe Sebastian K. King John M. Hutson David J. Cook Bridget R. Southwell 《Pediatric surgery international》2009,25(6):465-472
Abstract Chronic constipation in children is common and produces significant morbidity. Identification of the site of dysmotility in
constipation may determine the cause and permit directed management. Scintigraphy differentiates constipated patients with
anorectal hold-up from those with colonic slowing. Adults with colonic slowing demonstrate variation in the site of hold-up.
However, in children with colonic slowing, variability in the site of hold-up has not been investigated.
Purpose The current study aimed to characterise colonic transit patterns in 64 children with chronic idiopathic constipation.
Methods Scintigraphic images were grouped visually by their transit patterns. Intra-observer variation was assessed. Scintigraphic
data were analysed quantitatively.
Results Visual analysis of scintigraphy studies demonstrated normal transit (11/64), anorectal hold-up (7/64) and slow colonic transit
(46/64). Transit characteristics in the slow transit group demonstrated three possible subgroups: pancolonic slowing (28/46),
discrete hold-up in the transverse colon (10/46) and abnormal small and large bowel transit (8/46). Kappa testing demonstrated
consistent characterisation (k = 0.79). Statistical analysis of scintigraphic data demonstrated highly significant differences from normal (P < 0.001) in the subgroups.
Conclusion Scintigraphy demonstrates three possible transit patterns in children with chronic constipation secondary to slow colonic
transit. 相似文献
19.
de Crom SC van Furth MA Peeters MF Rossen JW Obihara CC 《European journal of pediatrics》2012,171(5):795-800
Human non-polio enterovirus (EV) is the most important cause of aseptic meningitis in children. Only a few studies report
the lack of cerobrospinal fluid (CSF) pleocytosis in children with confirmed EV meningitis; however, the characteristics of
these children have not been well defined. This paper describes the clinical and laboratory features of EV meningitis in children
with no CSF pleocytosis. Clinical, laboratory, and virological data of Dutch patients <16 years diagnosed with EV meningitis,
between 2003 and 2008, were analyzed retrospectively. Data of children with and without CSF pleocytosis were compared. A total
of 149 children were infected with EV. Patients presented mainly with fever (n = 113), malaise (n = 43), abdominal pain (n = 47), and irritability (n = 61). Of the 60 patients with EV meningitis, 23 had no pleocytosis. Those who lacked CSF pleocytosis were younger [odds
ratio (OR) 1.00; 95% confidence interval (CI) 1.000–1.002; p = 0.001], had experienced drowsiness more (OR 9.60; 95% CI 2.24–41.15; p = 0.002), had lower white blood cell counts (OR 0.73; 95% CI 0.61–0.89; p = 0.001), and had higher C-reactive protein (OR 1.13; 95% CI 1.03–1.23; p = 0.006) than those with pleocytosis. Conclusion. These findings show that EV meningitis occurs in the absence of CSF pleocytosis, particularly in young infants, meaning
that EV meningitis in this age group cannot be solely excluded by the absence of CSF pleocytosis. They also confirm the importance
of genome detection in the diagnosis of EV meningitis in young infants. 相似文献
20.
Encopresis is fecal soiling associated with functional constipation in a child. Constipation and encopresis are common problems
in children. Encopresis is most common between ages 3 and 7 years. Infants and pre-school children present with a history
of constipation and withholding maneuvers. The school-age child may have constipation and fecal soiling for some time prior
to detection. In some children encopresis is associated with enuresis and urinary tract infection. Family education is the
essential first step in management, followed by disimpaction of stool and complete evacuation of the rectum. Reaccumulation
of stool should be prevented by appropriate use of laxatives and stool softeners. This is followed by a gradual weaning of
the laxative regimen and instituting toilet training. Relapses may occur. Up to 50–60% of children achieve acceptable bowel
control, free of soiling, within a year. 相似文献