RESUMEN
A case study of a 9-year-old girl is presented which suffers from elective mutism and a rare, special form of cerebral seizures (ESES). After a brief review of the literature concerning these two rare diseases diagnosis, psychotherapy and anticonvulsive treatment as well as a follow-up are described. It is argued that in this case there are two independent, very rare diseases, and problems are discussed which arise from the necessity to integrate two heterogeneous therapeutic concepts.
Asunto(s)
Epilepsia Generalizada/complicaciones , Mutismo/complicaciones , Fases del Sueño , Anticonvulsivantes/uso terapéutico , Niño , Terapia Combinada , Epilepsia Generalizada/psicología , Epilepsia Generalizada/terapia , Femenino , Humanos , Mutismo/psicología , Mutismo/terapia , Polisomnografía , Psicoterapia , Estado Epiléptico/complicaciones , Estado Epiléptico/psicología , Estado Epiléptico/terapia , SíndromeRESUMEN
Aminoacid and oligopeptide formulas of low molecular weight have frequently been used in the past on an empirical basis for nutritional support of patients with Crohn's disease. Improvement of intestinal symptoms and laboratory parameters reflecting the inflammatory process have been demonstrated. Only a few controlled therapeutic trials have compared elemental diets with conventional drug therapy. In small bowel involvement, therapeutic efficiency in active disease is as good as salazosulfapyridine combined with corticosteroids. Elemental diet is less effective in large bowel disease. In the therapeutic application of elemental diets in active disease these formulas should be the only nutritional source for the patient. Particularly in small bowel disease the growth retarding side effects of corticosteroids can markedly be reduced by elemental diets. Children with moderate disease and additional growth retardation may benefit from either supplemental elemental diet and/or high molecular weight formula or from parenteral hyperalimentation. --Crohn-specific fistulas seem to close rarely on elemental diets while favourable results are seen in postoperative fistulas.
Asunto(s)
Enfermedad de Crohn/terapia , Alimentos Formulados , Estatura , Peso Corporal , Niño , HumanosRESUMEN
Since the seventieth low molecular weight formulas, "elemental diets", are applied in acute Crohn's disease in addition to drug therapy. In small bowel involvement, therapeutic efficiency in active disease is as good as salazosulfapyridine combined with corticosteroids. Physiological changes under elemental diet have been reported: decrease of gastric and pancreatic secretion, changes of bacterial bowel flora and in patients with Crohn's disease decreased fecal bile acid excretion and decreased intestinal losses of lymphocytes were described. Further, the absence of allergens in the formula and the quick and complete resorption are discussed to be important to clinical improvement in Crohn's disease. Indications for elemental diet are acute small bowel disease, intestinal obstruction, malnourishment and growth retardation. Further studies are needed to examine if elemental diets are effective in gastrointestinal fistulas and extraintestinal symptoms in Crohn's disease.
Asunto(s)
Enfermedad de Crohn/dietoterapia , Alimentos Formulados , Niño , Estudios de Seguimiento , Humanos , Fístula Intestinal/dietoterapia , Obstrucción Intestinal/dietoterapia , Cicatrización de HeridasRESUMEN
Out of 540 children and adolescents from the Multicenter Pediatric Crohn's Disease Study Group, 42 patients presented with decompensated intestinal obstruction. In 26 patients only one intestinal obstruction occurred, and in 16 children up to five intestinal obstructions occurred. Conservative measures were successful in 37 of 72 episodes of intestinal obstruction (51.4%), while 19 of 42 patients underwent emergency surgery (45.2%) and 16 of 42 (38.1%) were operated on following conservative treatment. From analysis of clinical, intraoperative, and histological findings in surgically treated patients, criteria for emergency surgery and elective surgery of intestinal obstruction in Crohn's disease are derived. One patient with adenocarcinoma of the large bowel, presenting with recurrent obstruction, signals caution in delaying proper diagnosis.