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From the beginning of the antibiotherapy, diarrhea frequently occurred as a side effect of the treatment. The spectrum of diarrheal disease associated with antibiotic therapy ranges from antibiotic associated diarrhea and colitis, to the more severe pseudomembranous colitis, which is always associated with Clostridium difficile (CD). Because most of the antibiotics are not active against this sporulated Gram positive anaerobe. The pathogenic process occurs only by production of toxins. CD is now recognized as one of the most important hospital infections. Although therapy is available for the majority of patients with CD infection, pseudomembranous colitis is a serious disease which, if untreated, can lead to major complications.

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From the beginning of the antibiotherapy, diarrhea frequently ocurred as a side effect of the treatment. The spectrum of diarrheal disease associated with antibiotic therapy ranges from antibiotic associated diarrhea and colitis, to the more severe pseudomembranous colitis, wich is always associated with Clostridium difficile (CD). Because most of the antibiotics are not active against this sporulated Gram positive anaerobe. The pathogenic process accurs only by production of toxins. CD is now recognized as one of the most important hospital infections. Although therapy is available for the majority of patients with CD infection, pseudomembranous colitis is a serious disease which, if untreated, can lead to major complications. (AU)

Asunto(s)

RESUMEN

From the beginning of the antibiotherapy, diarrhea frequently ocurred as a side effect of the treatment. The spectrum of diarrheal disease associated with antibiotic therapy ranges from antibiotic associated diarrhea and colitis, to the more severe pseudomembranous colitis, wich is always associated with Clostridium difficile (CD). Because most of the antibiotics are not active against this sporulated Gram positive anaerobe. The pathogenic process accurs only by production of toxins. CD is now recognized as one of the most important hospital infections. Although therapy is available for the majority of patients with CD infection, pseudomembranous colitis is a serious disease which, if untreated, can lead to major complications.

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Fourteen patients between the ages of 9 months and 5 years with chronic diarrhea and giardiasis were studied. Ten were eutrophic and 4 undernourished. The parasitological diagnosis was based on stool examination, a trophozoite search in duodenal aspiration, mucus adhered to mucosa and parasite identification in the intestinal biopsy material. Functional intestinal absorption studies, IgA determination in intestinal secretions and immunofluorescence studies were made. After the tests, tinidazole in suspension was administered at 60-70 mg/kg in one single oral dose. Patients were clinically re-evaluated and tests were done again after 30 days. The purpose of this paper was to evaluate the changes in the functional morphologic and immunologic studies and the therapeutic efficacy of the drug in a single dose. Nine patients had good clinical results, 2 fair and 3 were not evaluated due to celiac disease. All had negative results on the parasitological tests after treatment. There was no relationship between the number of parasites and the severity of symptoms. There was no significant difference between stool fat and d-xylose at the time of diagnosis and 30 days after the administration of tinidazole. The lactose tolerance test presented a significant difference (p less than 0.05) in the disaccharide absorption after treatment. The secretory IgA revealed significantly lower value (p less than 0.01) with respect to the normal values. The immunofluorescence showed productive IgA cells in all cases. The histologic changes were: mild enteropathy (grade I) in 6 patients; moderate (grade II) in 5; and severe (grade III-IV) in 3. Improvement of the mucosa was seen in 6 patients.

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Five patients with CF (cystic fibrosis) dead between 1974 to 1982 at ages ranging from one to six months are presented. All of them showed edema, hypoalbuminemia and anemia in a severely compromised clinical situation, and failure to gain weight in spite of being breast-fed in the first weeks of life, in four of them. All of them were second or third degree malnourished babies (Gomez classification) at admission. Five children presented edema, two severe, two moderate and one mild. Hematocrit values ranged from 19% to 39% (means 26.4%), and albuminemia from 1.60 to 3.00 g/% (means 2.14 g/%). Two patients presented antecedents of dead brothers. All of them received substitution therapy with pancreatic enzymes. The children dead within seven and seventeen days of admission (means ten days) of broncho-pulmonar disfunction. In this work, we wish to call the pediatrician's attention about the importance of making this diagnostic presumption in the first months of the life.

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527 patients whose ages ranged from 3 months to 5 years, with acute diarrhea were studied. 517 showed satisfactory response to treatment. Diarrhea persisted in 10 patients (2 %) and bile acids were determined in intestinal juice before and after cholestyramine administration. 7 patients showed bile acids deconjugation, 6 of which cured clinically. 3 patients showed no deconjugation, and 1 of them improved after cholestyramine therapy. Side effects of drug were not observed.

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527 patients whose ages ranged from 3 months to 5 years, with acute diarrhea were studied. 517 showed satisfactory response to treatment. Diarrhea persisted in 10 patients (2

) and bile acids were determined in intestinal juice before and after cholestyramine administration. 7 patients showed bile acids deconjugation, 6 of which cured clinically. 3 patients showed no deconjugation, and 1 of them improved after cholestyramine therapy. Side effects of drug were not observed.

RESUMEN

527 patients whose ages ranged from 3 months to 5 years, with acute diarrhea were studied. 517 showed satisfactory response to treatment. Diarrhea persisted in 10 patients (2

) and bile acids were determined in intestinal juice before and after cholestyramine administration. 7 patients showed bile acids deconjugation, 6 of which cured clinically. 3 patients showed no deconjugation, and 1 of them improved after cholestyramine therapy. Side effects of drug were not observed.

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We present a 14 year old girl with a two years' history of colicky abdominal pain associated with the palpation of a tumor in the left upper quadrant of the abdomen. During these two years, the pain and the tumor appeared and disappeared spontaneously several times. In the operation we found a jejunojejunal intussusception, the head being a sessile polyp placed 20 cm from the ligament of Treitz. The pathological examination showed a polyp formed by mucosa similar to the gastric one with chief and parietal cells. We discuss the clinical pictures that can be associated with this pathological entity in this uncommon localization in opposition to the more common settling in Meckel's diverticulum.

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This paper describes our experience with pre-surgical diagnosis of Meckel's diverticulum. We used a naso-jejunal-ileal tube, through which, we injected small amounts of radio-opaque fluid and air, thus utilizing double contrast. In seven children diverticulum was shown to be present by radioscopic and radiographic techniques; this was later confirmed during laparotomy. X-ray findings were compared with Tc99 scanning results.

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We present a 14 year old girl with a two years’ history of colicky abdominal pain associated with the palpation of a tumor in the left upper quadrant of the abdomen. During these two years, the pain and the tumor appeared and disappeared spontaneously several times. In the operation we found a jejunojejunal intussusception, the head being a sessile polyp placed 20 cm from the ligament of Treitz. The pathological examination showed a polyp formed by mucosa similar to the gastric one with chief and parietal cells. We discuss the clinical pictures that can be associated with this pathological entity in this uncommon localization in opposition to the more common settling in Meckel’s diverticulum.

RESUMEN

This paper describes our experience with pre-surgical diagnosis of Meckel’s diverticulum. We used a naso-jejunal-ileal tube, through which, we injected small amounts of radio-opaque fluid and air, thus utilizing double contrast. In seven children diverticulum was shown to be present by radioscopic and radiographic techniques; this was later confirmed during laparotomy. X-ray findings were compared with Tc99 scanning results.

RESUMEN

We present a 14 year old girl with a two years history of colicky abdominal pain associated with the palpation of a tumor in the left upper quadrant of the abdomen. During these two years, the pain and the tumor appeared and disappeared spontaneously several times. In the operation we found a jejunojejunal intussusception, the head being a sessile polyp placed 20 cm from the ligament of Treitz. The pathological examination showed a polyp formed by mucosa similar to the gastric one with chief and parietal cells. We discuss the clinical pictures that can be associated with this pathological entity in this uncommon localization in opposition to the more common settling in Meckels diverticulum.

RESUMEN

This paper describes our experience with pre-surgical diagnosis of Meckels diverticulum. We used a naso-jejunal-ileal tube, through which, we injected small amounts of radio-opaque fluid and air, thus utilizing double contrast. In seven children diverticulum was shown to be present by radioscopic and radiographic techniques; this was later confirmed during laparotomy. X-ray findings were compared with Tc99 scanning results.