The prognosis of cyclical vomiting syndrome.

AIMS: The medium term prognosis of cyclical vomiting syndrome (CVS) was studied to determine the proportion of affected individuals who had gone on to develop headaches fulfilling the International Headache Society criteria for migraine. METHODS: Twenty six (76%) of 34 CVS sufferers identified from the authors' clinical records were traced, and all agreed to participate. Each child was matched to a control, and telephone interviews were conducted using a standardised questionnaire. RESULTS: Thirteen (50%) of the subjects had continuing CVS and/or migraine headaches while the remainder were currently asymptomatic. The prevalence of past or present migraine headaches in subjects (46%) was significantly higher than in the control population (12%). CONCLUSION: Results support the concept that CVS is closely related to migraine.     

Reflux nephropathy

This article reviews current concepts of reflux nephropathy, including the pathophysiology, diagnosis, relationship to infection, role in causing end-stage renal disease, and appropriate treatment and management. The condition is defined from a epidemiologic point of view herein, and attention also is given to possible progressions this condition can take.     

尿道膀胱反流的临床研究

目的 探讨人体是否存在尿道膀胱反流及其临床意义。方法 首次应用同位素检查方法对９例反复下尿路感染患儿和正常对照组３例儿童进行研究。结果 证实人体中尿道膀胱反流（ＵＶＲ）的存在。结论 尿道器质或功能性异常所引起的尿流改变及尿道外括约肌（ＥＵＳ）异常收缩是产生ＵＶＲ的重要机制。ＵＶＲ不但能诱发尿道感染（ＵＴＩ）,并且是ＵＴＩ迁延不愈的重要因素。     

Reflux uropathy

Although much remains to be learned, most pediatric nephrologists and urologists are now in comfortable agreement with the following assumptions: (1) Most reflux (primary reflux) is due to a congenital anatomic abnormality of the bladder trigone. (2) In many instances this anomaly improves with growth and development of the child so that the reflux may cease spontaneously. In low-grade (I-II) reflux with undilated ureters, approximately 75 to 85 per cent will stop refluxing. In higher grades (III-V) with dilated ureters, the cessation rate is in the range of only 25-30 per cent. (3) Although radiologic grading is helpful in predicting the likelihood of spontaneous cessation, it is possible to improve that predictability by cystoscopic evaluation of the size, configuration, and position of the ureteral orifice plus the length of the submucosal tunnel. (4) Reflux in combination with bacteriuria can and does lead to renal scarring. (5) Renal scarring probably does not occur in patients with primary reflux and normal voiding pressures in the absence of bacteriuria. (6) Renal growth may proceed normally despite sterile reflux. (7) A few refluxing patients, perhaps 10 per cent, will have bacteriuria despite continuous antimicrobials, and these "breakthrough" infections may cause renal scars. (8) Other patients prove either unwilling or unable to comply with continuous medications and are also vulnerable to scars. (9) A successful antireflux operation may not change the recurrence rate of urinary tract infections per se, but it almost eliminates the likelihood of pyelonephritic episodes and the necessity for further continuous antibiotics. Unfortunately, in patients with intermediate grades of reflux, it is not presently known whether an early surgical correction might be more effective in allowing normal renal growth, in avoiding renal scars, and in preventing eventual hypertension, which is present as a late complication in almost 20 per cent of the patients. The data to answer this important question should ultimately be forthcoming from the current International Collaborative Reflux Study.     

Reflux nephropathy

Vesicoureteral reflux may be associated with abnormalities of the renal parenchyma. The purpose of this review is to define what the parenchymal abnormalities are histologically, what their etiologies may be, how they are identified and what their long-term clinical impact may be. Two categories are recognized, renal dysplasia and post-infection, chronic pyelonephritis. The diagnostic gold standard is microscopic evaluation of biopsy specimens but renal scintigraphy can be used in the diagnosis of renal dysplasia versus chronic pyelonephritis. Potential long-term sequelae of reflux nephropathy include hypertension and renal insufficiency although these may occur infrequently. A review of the current literature is provided.     

Testing the psychogenic vomiting diagnosis. Four pediatric patients.

We treated four patients with chronic vomiting during childhood in whom a tentative diagnosis of psychogenic vomiting was made after an extensive evaluation. In each case, the diagnosis was reconsidered during the course of treatment, as observations about the patients and their response to interventions accumulated. In three instances, these observations did not fit those expected if the diagnosis of psychogenic vomiting was correct. This led to a reexamination of the organic evaluation and the discovery of an undiagnosed organic contribution to the vomiting. In the fourth patient, gastric emptying studies confirmed that there was a strong psychological contribution to the vomiting, and helped to more carefully define this contribution. Family and individual psychotherapy and treatment were aided by the greater clarity in diagnosis.     

Self hypnotherapeutic treatment of habitual reflex vomiting.

A 9 year old boy with intractable postprandial reflex vomiting was taught a self hypnotherapy technique incorporating relaxation exercises, mental imagery, and suggestions of symptom relief. The sequence was recorded on a personal stereo cassette tape. Vomiting was completely eliminated within four weeks. At 12 month review vomiting had not recurred.     

Outcome for children with cyclical vomiting syndrome.

OBJECTIVE: Cyclical vomiting syndrome (CVS) is a disorder that carries a significant burden of disease for children and their families. The aim of this study was to examine the outcome of a group of children diagnosed with CVS from 1993 to 2003. METHODS: Children diagnosed with CVS over a 10-year period were identified and a review of the clinical records was carried out to define demographic features and the spectrum of disease at presentation. The patient's parent was contacted to establish the child's current well-being. Ethical approval for the study was obtained. RESULTS: Fifty one children were diagnosed with CVS and 41 agreed to participate in follow-up. Mean age was 5.8 (SD 3.3) years at onset of CVS, 8.2 (SD 3.5) years at diagnosis, and 12.8 (SD 4.8) years at follow-up. Vomiting had resolved at the time of follow-up in 25/41 (61%) children. Sixteen of 41 (39%) children reported resolution of symptoms either immediately or within weeks of diagnosis. However, a large number of children from the group whose vomiting resolved and the group that were still vomiting continued to have somatic symptoms, with 42% of children suffering regular headaches and 37% having abdominal pain. 32 (78%) parents felt that the provision of a positive diagnosis and information made a significant impact on the severity of vomiting. CONCLUSIONS: While 60% of children with CVS have resolution of symptoms, a significant proportion of both those in whom symptoms have resolved and those in whom vomiting persists continue to suffer from other somatic symptoms.     

Severe lactose intolerance with lactosuria and vomiting.

An infant with lactose intolerance is described. A breast-fed infant developed vomiting at 3 weeks, and became dehydrated. Lactosuria, aminoaciduria, and liver damage were preesent. A milk-free diet led to rapid recovery. At 6 months a normal diet was well tolerated.     

酸和胆汁反流在胃食管反流病中的作用

目的探讨酸和胆汁反流在小儿胃食管反流病(GERD)中的作用及这两种反流的临床意义。方法应用便携式pH监测仪及胆汁监测仪同步监测12例GERD患儿及11例健康儿童的食管内24 h pH变化和胆汁反流情况。结果GERD组食管酸暴露时间(pH<4)较对照组显著增加(P<0.05);食管胆汁反流采用胆红素吸收值≥0.14的时间百分比表示,GERD组较对照组明显增高(P<0.05),且85%GERD患儿存在酸和胆汁混合反流。结论胆汁反流和酸反流同样常见于GERD患儿,在小儿GERD发病中起重要作用,同步监测食管内pH及胆汁变化对小儿GERD的诊断具有重要意义。     

Der gastro-oesophageale Reflux

Summary Five children who were operated upon for esophageal atresia, were examined by lateral fluoroscopy with TV control, because they were suffering from recurring bronchitis and bronchopneumonia. In all these cases we found a normal anastomotic side, which showed frequently a barrier for passage of the bolus. This happened also without any manifested stenoses at the anatomotic level. Therefore the former upper esophageal pouch constituted a little reservoir. In all these cases we also observed a very manifest esophageal reflux. With each refluxwave the former upper pouch was refilled again, and reflux was seen from this part into the oro and laryngopharynx with cough and occasional aspiration. We are convinced that these phaenomena are responsible to the recurring bronchitis and bronchopneumonia. For treatment we suggest no eating, 2–3 hours before sleeping and elevating of the cranial upper part of the bed. It is possible, that an antireflux operation like fundoplicatio may be indicated.