How to use perianal examination in children.

No examination of a child's abdomen or gastrointestinal system is complete without an examination of the 'backside' or perineum, however there is often reluctance among paediatricians to perform this examination routinely. This article aims to describe how to use perineal examination in infants and children. It discusses the indications and stepwise approach to performing a per-rectal examination and interpretation of the findings one could expect to encounter.

A severe bleeding diathesis in a 6-year-old girl secondary to a composite diagnosis of splenic hemangiomatosis and small bowel lymphangiomatosis.

A 6-year-old girl presented with presumed relapse of childhood immune thrombocytopenia. Investigations revealed deranged coagulation parameters, abnormal small bowel thickening, and splenomegaly. A clinically significant bleeding diathesis emerged which was refractory to most hemostatic interventions.

Clinical and metabolic effects of gluten free diet in children with type 1 diabetes and coeliac disease.

Background: Following the recommendations of The International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2000, our clinic started routine screening of children with type 1 diabetes (T1D) for coeliac disease (CD).

Objectives: To determine the short-term clinical and metabolic effects of gluten free diet (GFD) in a group of children with T1D and confirmed CD.

Methods: Data were collected on all children with T1D and CD between November 2000 and November 2007 before and 12 months after commencement of GFD.

Pepsin measured in induced sputum--a test for pulmonary aspiration in children?

Purpose: The purpose of this study was to investigate if pepsin measured in sputum is a useful marker of pulmonary aspiration secondary to gastroesophageal reflux (GER) in children. It is possible that the induced sputum procedure could cause GER and invalidate the results. The hypothesis stated that healthy children (those without history of respiratory or gastroesophageal symptoms) would not have pepsin detected in induced sputum.

Total Jejunoileal Intussusception: A Case Report and Literature review.

Small bowel intussusceptions are much less common than the ileocolic type, with jejunoileal intussusceptions being amongst the most rare1. We review the literature on small bowel intussuception, using a case of an 11-year-old girl with a jejunoileal intussusception involving the whole of the small bowel, from the level of the duodenojejunal flexure to the ileocaecal valve, as an illustrative history. The typical CT features of an intussusception and value of CT with regard to identification of complications are highlighted.

Peroperative Gastrograffin bowel lavage in gastroschisis.

Aims: The aim of the study was to evaluate potential benefits in the use of peroperative bowel lavage with Gastrograffin in neonates with gastroschisis.

Methods: A retrospective analysis of newborns with gastroschisis was performed over a 10-year period in 2 centers in the United Kingdom. Two groups were studied wherein one had peroperative bowel lavage with Gastrograffin and the other did not.

Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux-related pulmonary aspiration.

Objectives: Gastro-oesophageal reflux (GOR)-related aspiration is associated with respiratory disease, but the current "gold standard" investigation, the lipid-laden macrophage index (LLMI), is flawed. A specific marker of GOR-related aspiration should originate in the stomach, but not the lung. An assay to detect gastric pepsin in the bronchoalveolar lavage (BAL) of children was developed and validated.

Investigating painless rectal bleeding--is there scope for improvement?

Introduction: Most patients with recurrent painless rectal bleeding warrant endoscopic examination of the lower gastrointestinal tract. This is often limited to rectum or distal colon. The purpose of this study was to compare the diagnostic yield of limited colorectal endoscopy with total colonoscopy in children with recurrent painless rectal bleeding.

Hypopharyngeal and distal esophageal pH monitoring in children with gastroesophageal reflux and respiratory symptoms.

Purpose: Fundoplication is frequently required for gastroesophageal reflux (GER)-related respiratory disease. Correlation between esophageal pH data and respiratory symptoms is poor but may be improved by monitoring hypopharyngeal pH. Reflux to the hypopharynx is underestimated by salivary bicarbonate.

Nonulcer dyspepsia and Helicobacter pylori eradication in children.

Background: Controversy exists over Helicobacter pylori eradication therapy in the treatment of patients with nonulcer dyspepsia. The lack of pediatric studies has made it difficult to draw conclusions about the use of eradication in dyspeptic children. The aim of this study was to examine long-term symptom severity in pediatric patients with nonulcer dyspepsia and H pylori gastritis after H pylori eradication.

Do major televised events affect pediatric emergency department attendances or delay presentation of surgical conditions?

Objective: To investigate whether major televised sporting events influence the level of attendance at a pediatric emergency department or reduce subsequent surgical admissions.

Methods: A retrospective analysis of the number of emergency department attendances and subsequent surgical admissions on nights of televised Champions League soccer games, a major pan-European soccer tournament, was made. These figures were compared with paired nights with no live soccer television broadcast.

Risk factors for Helicobacter pylori infection in children: an examination of the role played by intrafamilial bed sharing.

Background: The exact mode of transmission of Helicobacter pylori is yet to be established. Close personal contact among family members appears to be a key factor. The aim of this study was to establish whether sharing a bed or bedroom with an infected family member is an important risk factor for primary childhood H.

Total family unit Helicobacter pylori eradication and pediatric re-infection rates.

Background: Re-infection with Helicobacter pylori is more common in children than adults, and it is generally accepted that the family unit plays a significant role in primary childhood infection. We investigated whether the family unit plays a significant role in pediatric re-infection and if eradication of H. pylori from the entire family reduces the risk of childhood re-infection.