Crohn disease and the gynecologic patient.

Although Crohn disease (CD) is considered an inflammatory bowel disease, extraintestinal gynecologic manifestations are varied, frequent, and oftentimes difficult to manage. Its predilection for young and reproductive-age women makes it an important disease process for the gynecologist to understand, as its complications can have long-term repercussions on the developmental, sexual, reproductive, and psychological health of affected women. Patients may present with a variety of vulvovaginal, perineal, perianal, and urologic complaints.

Retrospective review of propofol dosing for procedural sedation in pediatric patients.

Objectives: The purpose of this study was to determine the total propofol dose (mg/kg) for non-emergent pediatric procedural sedation and evaluate dosing differences with regard to a patient's sex, age, and body mass index. Adverse events were recorded and evaluated to determine whether certain patient groups were at a higher risk than others.

Methods: This study was a retrospective observational pilot study including patients 0 to 18 years of age admitted between January 2008 and November 2009 for non-emergent gastrointestinal endoscopic procedures or radiologic imaging, who received propofol for procedural sedation.

Reuse of negative CLOtest kits in children.

Background: The rapid urease test, CLOtest, is used frequently in endoscopy suites. In the developed world, a negative CLOtest result is extremely common. The question of whether reuse of previously negative CLOtest kits is appropriate in children and the cost saving of such a practice were investigated.

Shwachman syndrome: phenotypic manifestations of sibling sets and isolated cases in a large patient cohort are similar.

Objectives: With the use of clinical data from a large international cohort, we evaluated and compared affected siblings and isolated cases.

Study Design: Data from 116 families were collected, and patients conforming to our predetermined diagnostic criteria were analyzed. Phenotypic manifestations of affected siblings and singletons were compared with the use of t tests, Wilcoxon scores, and chi2 analysis.

Is cyclic vomiting syndrome related to migraine?

Objective: To examine the overlap between cyclic vomiting syndrome (CVS) and migraine by comparing 2 subsets of children with migraine-associated and non-migraine-associated CVS.

Methods: We studied all children <18 years of age who met the consensus criteria for CVS after presentation to our pediatric gastroenterology service from 1986 to 1998. The clinical patterns and responses to treatment were obtained from a combination of chart reviews and structured interviews.

Heterogeneity of diagnoses presenting as cyclic vomiting.

Objective: To establish the diagnostic profile in children who present with cyclic vomiting.

Methods: We studied 225 children < 18 years of age who presented to our pediatric gastroenterology service from 1986 to 1997 with at least three discrete episodes of vomiting between which they were well. To determine the diagnoses in those presenting with a pattern of cyclic vomiting, the results of diagnostic testing and responses to various treatments were obtained from a combination of chart review and structured telephone interviews.

The Internet as a source for current patient information.

Objective: The purpose of this study was to assess the quality of information a lay person could obtain from Internet (Net) sources regarding the treatment of childhood diarrhea. It also afforded an opportunity to evaluate the awareness and compliance of the general medical community with the American Academy of Pediatrics (AAP) guidelines on the management of acute diarrhea.

Methods: This was a prospective, open, observational, literature review performed with a computer workstation and medical library.

Galactose-containing carbohydrates are preferentially absorbed in the neonatal pig colon.

Previous studies on the piglet colon in newborns cleared of bacterial metabolic activity showed a capacity for lactose absorption. Colonic absorption occurred at a flux rate equal to the assimilation of lactose by the small intestine but by a process that did not involve either glucose-galactose sodium cotransport or simple diffusion. Surprisingly, colonic lactose transport did not require either fermentation or cleavage of the disaccharide for uptake.

Gastrointestinal gas formation and infantile colic.

Gastrointestinal gas causes distress in many patients and their parents. Most often, patients do not have an actual increase in gastrointestinal gas volume, but rather their complaints derive from a misunderstanding of normal physiology, a misinterpretation of symptoms (colic), or an increase in intestinal sensitivity (irritable bowel syndrome). Symptoms from actual increases in intestinal gas volume are seen most frequently in children who swallow excessive amounts of air, have a dysmotility syndrome, or consume foods containing poorly absorbed carbohydrates.

Differentiating cyclic from chronic vomiting patterns in children: quantitative criteria and diagnostic implications.

Objective: To establish criteria to differentiate two patterns of vomiting and to identify the predominant diagnoses for each group.

Methods: All children 2 to 18 years of age referred to a pediatric gastroenterology service who presented with recurrent vomiting (three episodes of vomiting within a 3-month period) as a primary complaint from 1985 to 1991 were retrospectively reviewed (n = 106). The vomiting pattern (emeses per hour and episodes per month), diagnostic studies, and therapeutic responses were compared by Mann-Whitney U and chi-squared tests.

Constipation and dietary fiber intake in children.

Objective: Severe constipation in children is associated with rectal overdistension and insensitivity. Treatment typically involves three phases: disimpaction (days to weeks), laxative use (months), and a high-fiber diet (lifelong). The purpose of this survey is a discussion of therapies that recognize the unique problems that children with severe constipation have.

The prevalence of nausea and vomiting in pediatric patients receiving home parenteral nutrition.

We have observed that many home parenteral nutrition (HPN) recipients experience nausea, vomiting, or both during cyclic parenteral nutrition infusions. The current investigation was performed to determine the prevalence and course of these symptoms and effectiveness of therapeutic maneuvers. Eighty-nine recipients of HPN were contacted and 53 families (60%) responded.

Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy.

We conducted a randomized, double-blind trial evaluating the efficacy and safety of meperidine 2 mg.kg-1 (M) and meperidine 2 mg.kg-1 plus midazolam 0.

Lactose flux occurs by differing mechanisms in the colon and jejunum of newborn piglets.

The unidirectional flux of 10- and 40-mM lactose was studied in newborn porcine jejunum and colon mounted in Ussing chambers. Polyethylene glycol 400 was used to measure passive paracellular permeability. The mucosal-to-serosal flux and the tissue accumulation of labeled lactose from the colon was similar to that of lactose-derived glucose from the jejunum.

Efficacy of diazepam and meperidine in ambulatory pediatric patients undergoing endoscopy: a randomized, double-blind trial.

Medications are routinely administered to children prior to upper gastrointestinal endoscopy procedures. We evaluated the efficacy and safety of four dosage regimens: meperidine 2 mg/kg (M); low-dose meperidine 1 mg/kg and diazepam 0.1 mg/kg (M low+D); high-dose meperidine 2 mg/kg and diazepam 0.

Is combination therapy for encopresis nutritionally safe?

Chronic constipation accounts for 3% to 5% of pediatric primary care outpatient visits. The most severely affected of this group develop a flaccid colon insensitive to distention, and encopresis. Laxatives and lubricants have been the standard therapeutic agents during the bowel decompression phase of encopretic therapy.

Rectal myopathy in chronically constipated children.

We examined full-thickness rectal biopsies from 30 children who had chronic constipation, including 5 children with constipation associated with clinical symptoms of intestinal pseudo-obstruction. Biopsies from 9 patients who required colonic interposition and from 7 with Hirschsprung's disease were used as controls. Tissues were evaluated for muscularis mucosae thickness (in mm), for absolute circular and longitudinal muscle layer thicknesses and their ratio, and for the intensity of neural vasoactive intestinal peptide (VIP) immunohistochemical staining.

Enterohepatic distribution of carnitine in developing piglets: relation to glucagon and insulin.

L-Carnitine plays a crucial role in the perinatal transition from carbohydrate to lipid-derived energy. To examine the potential contribution of assimilated dietary carnitine to the elevated hepatic concentrations in newborns, we measured carnitine concentrations in sow milk, jejunum, and liver, and in vitro jejunal carnitine transport in piglets aged 1-36 d. Hepatic and sow milk total carnitine concentrations peaked soon after birth and declined with age (p = 0.