Thrombocytosis Associated with Solid Tumors in Children

The association between thrombocytosis and malignant disease was first described by Levin and Conley in 1964¹ but its pathogenesis remains unknown. We have studied the platelet counts in 108 children with solid tumors presenting to this hospital over the last 5 years. Thrombocytosis was defined as a platelet count over 400 × 10⁹/L and was noted in 43 children (40%) at presentation; in the great majority of cases the thrombocytosis could not be ascribed to infection or hemorrhage. The platelet counts in relation to the six commonest diagnoses are shown in Figure 1. The association was particularly marked in the case of hepatic tumors, where 8 out of 10 patients had platelet counts at presentation above 400 × 10⁹/L with a mean of 647 ± 306 (SD) × 10⁹/L (range 294-1310). Thrombocytopenia (platelet count less than 150 × 10⁹/L) was noted in 5 children at presentation; 2 of these had morphological evidence of bone marrow infiltration.     

Difference in plasma bilirubin concentration between monozygotic and dizygotic newborn twins

Aim: To investigate whether inherited factors, other than those already known, influence the bilirubin concentration in neonates of northern European descent, by comparison of monozygotic and dizygotic twins with respect to differences in the plasma bilirubin concentrations between the twins. Methods: 77 healthy pairs of twins of the same gender with a gestational age ≥250 d and of northern European descent were included. Fourth postnatal day blood sampling was done. A multiple linear regression analysis was carried out with the difference in serum bilirubin concentration between the twins as the independent factor, and zygosity, gender, gestational age, postnatal age, maternal smoking, ABO blood-type incompatibility, and the differences between the twins in blood haemoglobin concentration, formula feeding and weight loss as dependent factors. Results: 27 pairs of twins were monozygotic and 50 pairs dizygotic. The analysis showed that the difference in serum bilirubin concentration between the twins was dependent on whether the twins were monozygotic or dizygotic, i.e. the estimated difference in serum bilirubin concentration between the monozygotic twins was 17.8 μmol l^-1 [SE 6.6 μmol l^-1, p = 0.02, 95% confidence interval (95% CI) 3.4, 32.3 μmol l^-1] less than the difference between the dizygotic twins, adjusted for the above-mentioned potential confounders. The difference in serum bilirubin concentration between the twins was positively correlated to the difference in weight loss (%) between the twins (adjusted estimate 5.2 μmol l^-1, SE 2.1 μmol l^-1, p = 0.01, 95% CI 1.2, 9.3 μmol l^-1).

Conclusion: In a population of northern European descent, other genetic factors than gender and ABO blood type were significant for the plasma bilirubin concentration in healthy infants.     

Which one is a risk factor for chemotherapy-induced febrile neutropenia in childhood solid tumors: early lymphopenia or monocytopenia?

Neutropenia is one of the undesirable effects of cancer chemotherapy, sometimes causing life-threatening events. The present study was conducted to identify the risk factors of neutropenia caused by chemotherapy. Between January 2001 and March 2004, a total of 77 children with 165 neutropenic attacks were enrolled in this study. Complete blood count was performed before chemotherapy and on days 1, 3, 5, 7, and 9 consecutively. The complete blood count results of the febrile neutropenia (FN) group were compared to those of the non-FN group. The incidence of FN was significantly higher in patients with ANC counts ≤0.5 × 10⁹/L on days 3, 5, and 7, lymphocyte counts ≤0.5 × 10⁹/L on days 7 and 9, ≤0.7 × 10⁹/L on days 5, 7, and 9, and with monocyte counts ≤0.15 × 10⁹/L on days 7 and 9, respectively. Further statistical analysis showed that lymphocyte count ≤0.7 × 10⁹/L on day 5, and monocyte count ≤0.15 × 10⁹/L on day 7 were independent risk factors for FN. The authors conclude that lymphocyte counts on the 5th day can be more a predictive factor than monocyte count.     

Linezolid-induced reversible bicytopenia in a 4-year-old boy with methicillin-resistant Staphylococcus aureus bacteremia

The authors report on a 4-year-old child with the diagnosis of tetralogy of Fallot (TOF) and infective endocarditis. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture of the patient. While receiving imipenem, amikacin, and linezolid therapies, the boy's general condition improved, acute phase reactants decreased, and his blood culture became negative for MRSA. On his follow-up echocardiography, the vegetation had also disappeared. However, he developed progressive bicytopenia following linezolid therapy for 5 weeks. During linezolid therapy, his hemoglobin level decreased from 12.1 to 5.3 g/dL and his platelet count from 242 × 10⁹ to 14 × 10⁹/L. His white blood cell count (WBC) did not decrease during linezolid therapy. Six days following termination of linezolid therapy, his hemoglobin had increased to 8.2 g/dL and platelet count to 192 × 10⁹/L. Thus, it should be kept in mind that linezolid may induce cytopenias in children. If these side effects of linezolid are known, unnecessary laboratory investigations may be prevented and cessation of the drug may be sufficient for reversal of the cytopenias.     

Scedosporium Inflatum: First Case Report of Disseminated Infection and Review of the Literature

A 38-month-old boy presented with several weeks history of weight loss, irritability, poor appetite, and low-grade fever. Physical examination revealed a firm abdominal mass and CAT scan a6.7 × 6.2 × 11 cm left suprarenal tumor. Biopsy confirmed a neuroblastoma and staging demonstrated disseminated disease. Biological markers were uniformly unfavorable [elevated neuron-specific enolase (140 μg/L) and ferritin (349 μg/L), N-myc amplification, unfavorable history,¹ and inverted VMA (vanillylmandelic acid)/HVA (homovanillic acid) urinary catecholamine ratio].     

Hand, foot and mouth disease in Singapore: a comparison of fatal and non-fatal cases

Aim: An epidemic of hand, foot and mouth disease (HFMD) occurred in Singapore between September and November 2000. During the epidemic, there were four HFMD-related deaths and after the epidemic, another three HFMD-related deaths. This study sought to determine the risk factors predictive of death from HFMD disease. Methods: The risk factors for fatal HFMD were determined by comparing clinical and laboratory findings between fatal cases (n = 7) and non-fatal controls (n = 131) admitted between September 2000 and April 2001. Enterovirus 71 positive fatal cases (n = 4) and non-fatal controls (n = 63) were also compared. Results: In total, 138 HFMD cases with a mean age of 32 mo were studied. The majority of fatal cases died from interstitial pneumonitis, of whom three also had brainstem encephalitis. Of the 131 non-fatal cases, 3 had concomitant infections (respiratory syncytial virus bronchiolitis, right-sided pneumonia, Haemophilus influenzae type b meningitis), 2 had aseptic meningitis, and 1 each had transient drowsiness, intravenous immunoglobulin-related complications and transverse myelitis. By multivariate logistic regression analysis, atypical physical findings (p = 0.0006), raised total white cell count (p = 0.0128), vomiting (p = 0.0116) and absence of mouth ulcers (p = 0.043) were predictive of a fatal course. Although previous epidemics have described neurogenic pulmonary oedema as the main cause of death, the fatal cases in this study died mainly from interstitial pneumonitis alone or with myocarditis or encephalitis.

Conclusion: Although HFMD is generally a benign disease, risk factors such as vomiting, absence of mouth ulcers, atypical presentation and raised total white cell count should alert the physician of a fatal course of illness.     

Cerebral excitatory amino acids and Na+, K+-ATPase activity during resuscitation of severely hypoxic newborn piglets

We tested the hypothesis that early brain recovery in hypoxic newborn piglets is improved by resuscitating with an O₂ supply close to the minimum level required by the newborn piglet brain. Severely hypoxic 2-5-d-old anaesthetized piglets were randomly divided into three resuscitation groups: hypoxaemic (n = 8), 21% O₂ (n = 8), and 100% O₂ groups (n = 8). The hypoxaemic group was mechanically ventilated with 12-18% O₂ adjusted to achieve a cerebral venous O₂ saturation of 17-23% (baseline; 45±1%, mean±SEM). During the 2h resuscitation period, extracellular aspartate and glutamate concentrations in the cerebral striatum were higher during hypoxaemic resuscitation (p = 0.044 and p = 0.055, respectively) than during resuscitation with 21% O₂ or 100% O₂, suggesting an unfavourable accumulation of potent excitotoxins during hypoxaemic resuscitation. The cell membrane Na⁺,K⁺-ATPase activity of cerebral cortical tissue after 2 h resuscitation was similar in the three groups (p = 0.30). In conclusion, hypoxaemic resuscitation did not normalize early cerebral metabolic recovery as efficiently as resuscitation with 21% O2 or 100% O₂. Resuscitation with 21% O₂ was as efficient as resuscitation with 100% O₂ in this newborn piglet hypoxia model.     

Nontuberculous mycobacterial adenitis: effectiveness of chemotherapy following incomplete excision

Background: Management of lymphadenopathy caused by nontuberculous mycobacteria (NTM) is primarily surgical. Where this cannot achieve sufficient clearance of infected nodes, chemotherapy is often given. Aim: This study compared results of surgery alone with surgery followed by chemotherapy in instances where there was incomplete surgical removal of diseased tissue. Methods: Chemotherapy comprised azithromycin 10 mg/kg and rifabutin 6 mg/kg both given once daily for 6 mo. Ninety-eight children with NTM infection were seen in the period 1990-2004. Sixty-eight cases with adenopathy where “time to healing” (discharge stopped and inflammation settled) was known were available to compare response to treatment. Results: The median (range) “time to healing” in weeks for 43 patients who had surgery alone was: incision and drainage (I&D)/curettage 6 (1-72) (n=10); excision 3 (1-28) (n=22); and from the last operation of multiple (repeat) surgery 3 (1-40) (n=11). For 25 patients who required chemotherapy in addition to surgery, the median (range) “time to healing” in weeks was I&D/curettage 10 (1-40) (n=17), excision 14 (8-20) (n=2) and multiple surgery 29 (2-88) (n=6).

Conclusion: In children with adenitis due to NTM, where surgical resection is followed by continued discharge and inflammation, chemotherapy should be considered before further surgery is undertaken.     

Attitudes and feelings towards menstruation and womanhood in girls at menarche

Aim: To elucidate early adolescent girls' attitudes, thoughts and feelings towards menstruation and their bodies. Methods: 309 12-y-old girls answered questionnaires. One part of the questionnaire dealt with thoughts and feelings towards menstruation. The other part dealt with thoughts and feelings towards menstruation and sex and ability to communicate on aspects of womanhood. Results: Postmenarcheal girls were less positive towards menstruation than premenarcheal girls (p=1×10^-6). Many girls (43%) did not reaffirm the statement “I like my body” and almost one quarter stated being teased for their appearance. Many of the girls claimed that they had been called “cunt” (38%) or “whore” (46%). If called “cunt” or “whore”, 17% stated that they felt alone, 76% felt anger and 50% were offended. Mothers were those with whom girls could most easily “chat” about their period. Sixty-seven per cent received information about menstruation from school nurses.

Conclusion: Wanting to be an adult and liking that their body develops seem to be associated with a more positive feeling towards menstruation. Furthermore, mothers' timing and ability to communicate attitudes towards menstruation and the body are as important as those in a girl's immediate environment.     

Better care of immature infants; has it influenced long‐term pulmonary outcome?

Aims: To assess whether lung function in late childhood had improved in subjects born extremely prematurely in the early 1990s compared to the early 1980s, and whether neonatal factors in the respective periods had different impact on long-term pulmonary outcome. Design: Population-based, controlled cohort study. Lung function was determined in 81 of 86 (94%) eligible subjects born with gestational age ≤28 weeks or birthweight ≤1000 g in Western Norway in 1982-85 (n=46) and 1991-92 (n=35), and in 81 matched control subjects born at term. Results: The incidence of bronchopulmonary dysplasia was similar in the two periods. At follow-up, airway obstruction, hyper-responsiveness and pulmonary hyperinflation were similarly increased in both preterm cohorts compared to matched controls. Furthermore, current lung function was similarly related to neonatal respiratory disease in both birth-cohorts: FEV₁ was reduced with respectively 18.6% and 18.7% of predicted in preterms dependent on supplemental oxygen at 36 weeks postmenstrual age. Lack of antenatal treatment with corticosteroids and prolonged neonatal oxygen treatment predicted similar significant airway obstruction in the two birth-cohorts.
Conclusion: Preterms born in different eras of neonatology had similar long-term decreases in lung function. Long periods of oxygen supplementation are still required to salvage immature infants, and airway obstruction may still be a common long-term outcome.     

Beta-glucuronidase in the diagnosis of bacterial meningitis and response to treatment

Aim: β-Glucuronidase activity is increased in the cerebrospinal fluid (CSF) of patients with bacterial meningitis. The aim of this study was to investigate the β-glucuronidase activity in the cell-free CSF of bacterial meningitis and its course during treatment, and compare it with other CSF parameters. Methods: The β-glucuronidase activity, cell number, protein concentration and CSF/blood glucose ratio were measured in 43 consecutive infants and children with bacterial meningitis, and 97 control subjects. Patients had one or two follow-up lumbar punctures. Results: The β-glucuronidase activity was increased early in bacterial meningitis, even when the other CSF parameters were undisturbed. Before treatment, the median activity in affected children was 136 μmoles 4-methylumbelliferone l ^-1  h ^-1 (range 44-826) and in controls 14 (7-23). In all patients who improved, the activity was lower in the follow-up CSF samples. Six to 12 h after starting treatment, the median activity was already reduced by 59%. The other CSF parameters showed a variability during the first 24 h of treatment independently of the course of the disease. Multiple comparisons of the CSF parameters in 17 patients who had two follow-up punctures showed that the β-glucuronidase activity was the best prognostic index.

Conclusion: β-Glucuronidase activity in the CSF is a reliable indicator of bacterial meningitis, which can identify the response to treatment early in the course of illness. The enzyme activity is increased early in the disease, even when the other laboratory parameters from the CSF remain normal.     

Recovery of metabolic acidosis in term infants with postasphyxial hypoxic-ischemic encephalopathy

Aims: To describe the base deficit (BD) values and the rate of postnatal recovery of the BD of infants with hypoxic ischemic encephalopathy due to intrapartum asphyxia; and to explore the relationships between the rate of recovery of BD, severe adverse outcome and different time patterns (acute total vs prolonged partial) of asphyxia. Methods: Clinical and laboratory data were collected from the neonatal period (n = 244) and outcome data to a minimal age of 1 y (n = 218). Rates of recovery of BD were described in four 60 min blocks of time. The values of rate of recovery were compared between the outcome groups, ignoring correlation structure within subjects and with adjustment by the generalized estimating equations method. Results: The BD normalized within 4 h of birth in all but 9 of 244 infants. The rates of recovery of BD in infants with good and severe adverse outcome respectively were 0.11 [95% confidence interval (95% CI) 0.07, 0.14] and 0.09 (95% CI 0.07, 0.12) mmol l ^-1 min ^-1 over the first 4 h after birth. The rates of recovery were similar with or without buffer therapy, and after acute near-total and prolonged partial asphyxia.

Conclusion: The BD in the great majority of infants with severe intrapartum asphyxia normalizes within 4 h of birth. The BD recovery rate of infants with adverse outcomes was similar to those with relatively good outcome. The different time patterns of asphyxial episode were not associated with differential recovery profiles.     

Randomized controlled trial of intrapleural streptokinase in empyema thoracis in children

Aim: To compare intrapleural streptokinase and placebo in paediatric empyema. Methods: Children with empyema greater than stage 5 received intrapleural streptokinase (n = 19) or normal saline (n = 21) along with intercostal drainage. Clinical and serial sonographic outcomes were compared. Results: Although there was no difference in clinical and sonographic outcome, none of the children with stage 7 empyema (multi-loculated empyema) who received streptokinase developed pleural thickening 30 d later.

Conclusion: There is no short-term clinical benefit of intrapleural streptokinase in paediatric empyema; this therapy may be reserved for those with stage 7 empyema to prevent pleural thickening in the long term.     

Bronchial responsiveness to methacholine and adenosine 5'-monophosphate (AMP) in young children with post-infectious bronchiolitis obliterans

Aim: Bronchial hyperresponsiveness (BHR) is a characteristic feature of asthma, but it is also frequently demonstrated by children and adults with chronic obstructive lung diseases. BHR is usually measured by bronchial challenges using direct or indirect stimuli. The aim of this study was to compare these two types of bronchial challenge in young children with post-infectious bronchiolitis obliterans (BO). Methods: Methacholine and adenosine 5'-monophosphate (AMP) bronchial challenges were performed on preschool children with post-infectious BO (n=18), those with asthma (n=23) and in controls (n=20), using a modified auscultation method. The endpoint was defined as the appearance of wheezing and/or oxygen desaturation. Results: A positive response to methacholine (an endpoint concentration ≤8 mg/ml) was observed in 88.9% (16/18) of the patients with post-infectious BO, but a positive response to AMP (an endpoint concentration ≤200 mg/ml) was observed in only 22.2% (4/18). All patients with asthma responded positively to methacholine, and most (21/23, 91.3%) of them also responded positively to AMP. The majority of the controls were insensitive to both challenges.

Conclusion: BHR to methacholine is a frequent, but by no means universal, finding in young children with post-infectious BO, but is usually not accompanied by BHR to AMP.     

Autologous Rescue with Blood-Derived Stem Cells in a Child with Non-Hodckin'S Lymphoma

Autologous blood-derived stem cells were used for stem-cell rescue in a 5-year-old boy with chemotherapy-resistant B-Non-Hodgkin's lymphoma (B-NHL) involving bone marrow. The high dose chemoradiotherapy was carried out 5 months after initial diagnosis during partial remission. The preparative regimen consisted of 12 Gy fractionated, total-body irradiation (FTBI) before 60 mg/kg etoposide. There were 22.96 × 10⁴/kg body weight myeloid precursor cells, granulocyte-macrophage committed stem cells (CFU-GM) collected by intermittent blood flow separation with a Haemonetics 30^R in two cytaphereses and stored in liquid nitrogen. Also 11, 82 × 10⁴ CFU-GM/kg body weight were recovered and transfused after thawing. Rapid hematopoietic reconstitution ensued: Erythroid precursors were detected on day 9, 1 × 10⁹/L leucocytes were counted on day 11, and 0.5 × 10⁹/L granulocytes on day 13, respectively. The patient required 3 single-donor platelet transfusions, the last one on day 10. On day 17, 100 × 10⁹/L platelets were reached. A bone marrow aspirate on the same day showed good trilineage regeneration. The patient remained in complete remission 7 months after autografting with a normal stem cell content of the bone marrow and in the peripheral blood. On day 226, after stem cell infusion, a bone marrow relapse occurred.     

Antiphospholipids antibodies in a 12-month-old presenting with idiopathic thrombocytopenic purpura

A 12-month-old Caucasian female with a history of recurrent ear infections presented to the emergency room with petechiae, severe thrombocytopenia (4000/μL), and abnormally prolonged activated partial thromboplastin time. Further autoantibody investigation detected antinuclear antibodies, anti-double-stranded DNA, and antiphospholipid antibodies. Platelet count, in response to intravenous immunoglobulin infusion, increased to more than 100 × 10³ plt/μL. At 6-month follow-up, no positive autoantibodies were detected.     

Effects of hypoxia on the complexity of respiratory patterns during maturation

During hypoxic gasping, the hypoxic neurogram has a steeper rate of rise, an augmented amplitude, and a shorter duration than is seen during eupnea. Because hypoxia reduces neural activity, we hypothesized that gasping would be characterized by low complexity (irregularity) values compared with eupnea in piglets. In this study, we define and quantify changes in the complexity of the phrenic neurogram, the output of the respiratory neural network in piglets using the approximate entropy (ApEn) method which provides a model independent measure of the complexity of the phrenic neurogram.

The phrenic neurogram in vagotomized, peripherally chemodenervated, decerebrated piglets was recorded from the C5 phrenic nerve during eupnea and gasping at four postnatal ages; 3–6 days of age (n=8), 7–13 days of age (n=3), 15–21 days of age (n=4), 29–35 days of age (n=10). Nonlinear dynamical analysis of the phrenic neurogram was performed using the approximate entropy method. The mean approximate entropy values for a recording of 5 consecutive breaths during eupnea and 6–29 consecutive breaths during gasping for each piglet in each group during eupnea was calculated.

Our results suggested that the mean approximate entropy values for the 3–6 days age group were 1.46±0.003 during eupnea and 0.85±0.001 during hypoxic gasping. For the 7–13 days age group, the mean approximate entropy values were 1.35±0.009 during eupnea and 1.00±0.001 during hypoxic gasping. For the 15–21 days age group, they were 1.33±0.005 during eupnea and 0.94±0.001 during hypoxic gasping. Finally, for the 29–35 days age group, they were 1.38±0.002 during eupnea and 0.93±0.001 during hypoxic gasping. The shift from eupnea to gasping caused a drastic drop in the mean values of the approximate entropy values at each of these four age groups. These differences in the complexity values of the phrenic neurogram between eupnea and gasping are statistically different at each age group (p<0.001).

These findings suggest that during hypoxic gasping, regardless of degree of development, the output of the central pattern generator becomes less complex probably because hypoxia reduces the neural activity.     

Clinical relevance of Ureaplasma urealyticum colonization in preterm infants

A cohort of 78 infants of gestational age less than 34 weeks was examined for Ureaplasma urealyticum colonization and neonatal morbidity. Ureaplasma urealyticum was cultured from nasopharyngeal, endotracheal and blood-culture samples. A child was considered as being colonized if any sample was positive. The children with perinatal U. urealyticum colonization (n = 11; 14%) differed from those with no colonization (n = 67) in two important aspects: (i) they had higher leucocyte counts on the first (18.6 vs 12.4 109) and the second (29.0 vs 15.4 109) days of life ( p = 0.01, both days); and (ii) they more often needed high-frequency oscillatory ventilation (45% vs 13%, p = 0.02). This study showed that U. urealyticum colonization is associated with signs of the host defence response together with symptoms of respiratory tract involvement suggesting the pathogenicity of U. urealyticum in premature infants.     

Efficacy of Helicobacter pylori eradication on platelet recovery in children with chronic idiopathic thrombocytopenic purpura

Aim: Little is known about the influence of environmental factors on the epidemiology of idiopathic thrombocytopenic purpura (ITP). The role of Helicobacter pylori infection in relation to the development and/or persistence of ITP in infected patients remains controversial. Therapy used for eradicating H. pylori has led to a rise in platelet counts in a significant number of adult patients, but few paediatric studies have been undertaken to evaluate such treatment. The aim of this prospective study was to determine the prevalence of H. pylori and to evaluate whether H. pylori eradication can induce chronic ITP regression in children. Methods: To investigate new, non-invasive techniques for diagnosis of H. pylori infection, an enzyme immunoassay for H. pylori antigens in faeces (HpSA) was evaluated. Patient eligibility criteria included isolated thrombocytopenia (≤50 × 10[Formula: See Text] L[Formula: See Text]) for more than 6 months without any identifiable cause and either normal or increased marrow megakaryocytes. H. pylori status was monitored before eradication and 4, 12, and 24 mo, after the end of treatment using Premier Platinum HpSA. Results: In this study we evaluated 22 chronic ITP patients, 9 of whom were infected with H. pylori. Using repeated HpSA testing, we demonstrated for eradication of H. pylori after treatment in all infected patients. Five of the nine patients had increased platelet counts that persisted throughout the follow-up period.

Conclusion: These results should stimulate additional research into the involvement of H. pylori infection in chronic ITP in childhood. This approach may offer an accepted algorithm at least for some of these patients.     

Upper endoscopic findings in children with active juvenile chronic arthritis

Aim: To investigate the association between gastroduodenal mucosal damage and symptoms of the digestive tract in children with juvenile chronic arthritis (JCA) Methods: This was a prospective, open, non-randomized study. Gastroscopy was performed on 45 children with active JCA in 1996-2000. Gastrointestinal symptoms before and during the treatment were noted, as was the length of antirheumatic medication, for which the data were retrospectively assessed. Plasma haemoglobin (Hb) and mean corpuscular volume (MCV) levels and erythrocyte sedimentation rate (ESR) were analysed. Mucosal biopsies were obtained for histology and Helicobacter pylori culture. All patients were taking non-steroidal anti-inflammatory drugs (NSAIDs) and 11 (24.4%) were on peroral steroids; 16 (35.6%) were receiving hydorxychloroquine, 9 salazopyrine, 5 myocrisine and 14 methotrexate. Results: Seven children (15.6%) were found to have active inflammation in their gastric and/or duodenal mucosa, two having ulcers and two being infected with H. pylori. Abnormal endoscopic findings were more common in symptomatic children (n = 24) than in children without symptoms (n = 21) (75% vs 38%, p = 0.017). There was no clear association between the Hb or MCV level and the degree of gastroduodenal inflammation (p = 0.98 and 0.7, respectively). Significantly more children (66.6% vs 33.3%) experienced abdominal pain after beginning medical therapy than before therapy (p = 0.02).

Conclusion: Endoscopic evaluation of patients with JCA and receiving NSAIDs should be considered at least in symptomatic cases.