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Objectives: Anastomotic ulceration (AU) is a rare but life-threatening complication of pediatric short bowel syndrome (SBS). AUs may be challenging to detect and refractory to treatment. This study aimed to identify features associated with symptomatic bleeding AUs in children with SBS and factors that may impact resolution of bleeding. The relationship between dietary changes and symptomatic anastomotic hemorrhage was also explored.
Methods: We conducted a retrospective chart review of 381 patients cared for in the Intestinal Rehabilitation Program at our center from 2013 to 2022. Patients with symptomatic AUs were identified based on at least 1 endoscopic procedure showing AUs and evidence of clinically significant gastrointestinal bleeding. We collected patient demographics, clinical characteristics, dietary history, radiologic imaging, and histopathology. We used descriptive statistics to identify patterns of presentation.
Results: AUs were identified in 22 patients who were followed for a median duration of 2.9 years after anastomotic ulcer identification. AUs uniformly evolved years after the initial anastomosis (median 3.2 years). Characteristics included bowel stricture (4/22), small bowel-colon anastomosis (19/22), partial colectomy (17/22), and an increase in whole foods fraction (12/18). Bleeding resolved with operative intervention in the majority with anastomotic stricture (3/4). Recurrent bleeding was common in those without stricture (13/18). In a subset of patients without stricture, whole food reduction was associated with improvement or resolution of bleeding (5/6).
Conclusions: We observed a higher proportion of patients with AUs who responded to surgical intervention in the subset of children with definitive anastomotic strictures versus those without, suggesting that careful characterization of intestinal anatomy may be critical to predicting response to therapy. We also observed that bleeding from AU typically first manifested within 1 year of a shift from elemental or hydrolyzed enteral formula to a whole food-based diet (including commercial blenderized feeds), which may indicate that components of the enteral diet play a role in the pathogenesis of AU. Further studies are needed to validate these hypotheses.
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http://dx.doi.org/10.1097/MPG.0000000000003942 | DOI Listing |
Front Endocrinol (Lausanne)
December 2024
Department of Neurology, First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Background: Diabetic striatopathy (DS) is a rare disorder characterized by clinical manifestations of hemichorea, non-ketotic hyperglycemia, and high signal on T1-weighted MRI or high density on CT scan in basal ganglia, typically associated with poor glycemic control.
Objective: This study aimed to analyze clinical characteristics of patients with diabetic striatopathy to raise awareness amongst physicians, especially endocrinologists, about this rare neurological manifestation in patients with diabetes.
Methods: We retrospectively analyzed the data on clinical presentations, laboratory workups, and cranial CT and MRI of six patients with DS who were admitted to our hospital from October 2013 to June 2022.
J Epilepsy Res
December 2024
Department of Dermatology, National Institute of Medical Science and Nutrition Salvador Zubiran, Tlalpan, México.
Discontinuation of antiseizure medications (ASMs), primarily prompted by adverse effects, presents a formidable challenge in the management of epilepsy, and impacting up to 25% of patients. This article thoroughly explores the clinical spectrum of cutaneous adverse drug reactions (cADRs) associated with commonly prescribed ASMs. Ranging from mild maculopapular rashes to life-threatening conditions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), the diverse manifestations are meticulously detailed.
View Article and Find Full Text PDFNeurol Clin Pract
February 2025
University of Rochester School of Medicine and Dentistry (JS, AV); Center for Health and Technology (CHeT) (JS, JW, AV, SJR, CE, AA, CZ, CRH), University of Rochester; University of Utah Spencer Fox Eccles School of Medicine (SJR); Des Moines University College of Osteopathic Medicine (AA); Department of Biostatistics and Neurology (ND), University of Rochester; Alzheimer's Disease Care, Research and Education Program (AD-CARE) (AM, SS-S, EJS), University of Rochester; and Department of Neurology (CRH), University of Rochester.
Background And Objectives: In preparation for future clinical trials involving individuals with Alzheimer disease (AD), mild cognitive impairment (MCI), and dementia, it is important to ascertain the widespread impact of symptoms from the direct perspectives of patients and caregivers. In this study, we performed cross-sectional surveys using large-scale patient and caregiver data to identify the prevalence and average impact of symptoms and symptomatic themes experienced by adults with AD, MCI, and dementia. Subsequent analyses were used to determine which demographic and disease-specific factors are associated with more severe disease.
View Article and Find Full Text PDFEnviron Int
December 2024
Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing 100191, China; National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China. Electronic address:
Recent increases in nitrogen dioxide (NO) and ozone (O), two highly reactive and oxidative pollutants, have raised concerns about their potential impact on adolescent mental health. This study leveraged data from the Chinese National Survey on Students' Constitution and Health (CNSSCH) in 2019, a nationally representative cross-sectional survey of Chinese adolescents. A total of 149,697 adolescents aged 10-18 years were included in this study.
View Article and Find Full Text PDFJ Am Heart Assoc
December 2024
Hypertrophic Cardiomyopathy Center, Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH USA.
Background: In obstructive hypertrophic cardiomyopathy, myectomy improves symptoms, quality of life, and left ventricular (LV) outflow tract gradients. We prospectively evaluated the temporal changes in various echo parameters after myectomy.
Methods And Results: In 173 adults with obstructive hypertrophic cardiomyopathy (53±10 years, 63% men) who underwent myectomy between March 2017 and June 2020, clinical and blinded echo assessment (before and at 12±6 months follow-up) was performed prospectively (SPIRIT-HCM [Quality of Life and Functional Capacity Following Septal Myectomy in Obstructive Patients With Hypertrophic Cardiomyopathy]).
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