RESUMEN
AIM: To develop a system to define the degree of liver disruption and severity of portal hypertension in children based on the International Classification of Functioning, Disability and Health (ICF). PATIENTS AND METHODS: Studied the results of laboratory and instrumental methods 382 children: 267 patients with various liver diseases, including 49 patients who underwent liver transplantation, and 115 children without liver disease. RESULTS: Based on analysis of statistical data obtained were identified 10 indicators, a set of changes which can be used to assess the degree of disruption of the structure of the liver and the severity of portal hypertension: indicators that reflect the severity of fibrosis and cirrhosis of the liver (METAVIR score on a scale at fibroelastometrii, scores are Desmet at morphological study of the liver) and indicators that reflect the severity of portal hypertension (the diameter of the portal vein, splenic vein diameter, the length of the spleen, recanalization of the umbilical vein, esophageal varices, ascites, hydropericardium, hydrothorax). Each of the indicators was assessed on a 5-point system. Number of points reflects the sum of the changes of these parameters. Decrease the number of points on 0-4% (38-40 points) is regarded as a lack of structural failure of the liver and the severity of portal hypertension by 5-24% (30-37 points)--minor violations on 25-49% (20-29 points) -moderation disorders, 50-95% (3-12 points)--severe handicaps, 96-100% (0-2 points)--absolute violation. Studied the dynamics of children with autoimmune hepatitis, Wilson's disease and chronic hepatitis C. CONCLUSION: The proposed scoring system for assessing the degree of disruption of the structure of the liver and the severity of portal hypertension can be used as an objective criterion of the severity of the pathological process, to estimate the dynamics of defeat against the background of the therapy, determining the prognosis of the disease and as a criterion of the indications for liver transplantation.
Asunto(s)
Hipertensión Portal/clasificación , Hipertensión Portal/patología , Hígado/patología , Índice de Severidad de la Enfermedad , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
OBJECTIVE: Our aim was to on the basis of determining the degree of violation of the structure and function of the liver establish their relationships and to assess the dynamics of liver disease in its chronic illnesses in children. METHODS: With the help of the developed scoring systems were used to assess the degree of liver dysfunction and the degree of disruption of the structure of the liver and the severity of portal hypertension. RESULTS: The results of the diagnostic methods 252 children aged 1 to 17 years (mean age of 11.8±3,5) with Wilson disease (WD), autoimmune hepatitis (AIH), chronic hepatitis C (CHC) were analyzed; 48 patients underwent liver transplantation. In children with WD, AIHand CHC liverfunction reduced by 41.3±12.9% to 28.8±12.5% and 19.1±7.8% respectively. Structure of the liver in children with WD, AIH and CHC was disturbed by 25.0±8.1% to 20.4±9.2% and 6.8±4.4% respectively. Thefunction and structure violations of the liver more pronounced in liver cirrhosis. The use of the developed scoring systems to monitor the severity of liver damage in the dynamics and evaluation of the effectiveness of the therapy is demonstrated. The degree of liver dysfunction is directly dependent on the degree of its structure. Abnormal liverfunction ≥40% and ≥40% of its structure with treatment failure can be used as a criterion of indicationsfor elective liver transplantation with its chronic diseases in children. CONCLUSION: Developed a point system to determine liver function and a point system to determine disruption of the structure of the liver and the severity of portal hypertension in children can serve as an objective criterion for assessing the severity of liver disease, monitoring their changes in the dynamics with the assessment of the effectiveness of the therapy and making decisions about the need for routine liver transplantation in its chronic illnesses in children.
Asunto(s)
Hepatopatías/diagnóstico , Hígado/patología , Adolescente , Niño , Preescolar , Enfermedad Crónica , Femenino , Humanos , Lactante , Hepatopatías/metabolismo , Hepatopatías/fisiopatología , Pruebas de Función Hepática , Masculino , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
AIM: To analyze the value of confocal laser endomicroscopy in diagnostics of upper gastrointestinal tract mucosa changes in children. PATIENTS AND METHODS: In the current study a total of 116 children aged from 3 to 18 years old undergo conventional endoscopy with confocal laser endomicroscopy supplemented with mucosal biopsy followed by traditional histology in the period from 2011 until 2014. To determine the prognostic value of the of probe based CLE in the evaluation of normal and pathological changes of the esophageal mucosa a comparison of results of optical biopsy with the data obtained during the standard histological examination were performed. RESULTS: After results of probe-based CLE and traditional histology were comprised optical biopsy showed 88.8% sensitivity and 88.3% specificity to esophagitis with Spearmen correlation 0.79 (p = 0.001); 92.3% sensitivity and 95.3% specificity to metaplastic changes of esophageal mucosa with Spearmen correlation 0.85 (p = 0.001); 92.4% sensitivity and 95.2% specificity in differential diagnosis of esophageal polyps with Spearmen correlation 0.95 (p = 0.001). CONCLUSION: Confocal endomicroscopy may become one of the leading methods in pediatric gastroenterology since it allows the endoscopists to inspect the mucosa at the cellular level during the endoscopic procedure and can help in establishing the diagnosis.
Asunto(s)
Endoscopía del Sistema Digestivo/métodos , Enfermedades del Esófago/patología , Esófago/patología , Microscopía Confocal/métodos , Adolescente , Biopsia , Niño , Preescolar , Interpretación Estadística de Datos , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Microscopía por Video/métodos , Membrana Mucosa/patología , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
In this review history, principles, technique and clinical applications of confocal laser endomicroscopy are briefly described. This technology allows to expand the diagnostic ability of traditional white light endoscopy and to assess effectiveness of therapeutic procedures in different gastrointestinal diseases. New experimental and clinical data in assessing small bowel barrier dysfunction as a predictor of relapse for inflammatory bowel disease is presented. Problems and perspectives regarding application of optical biopsy for gastrointestinal tract in pediatric practice are discussed.
Asunto(s)
Enfermedades Gastrointestinales/diagnóstico , Tracto Gastrointestinal/patología , Microscopía Confocal , Niño , Humanos , Microscopía Confocal/instrumentación , Microscopía Confocal/métodos , Pediatría , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: Aim of the study was to assess the diagnostic yield of second-generation colon capsule in pediatric gastrointestinal diseases. PATIENTS AND METHODS: Five patients with different symptoms of gastrointestinal diseases were included in the study. Among them were: suspicion on diffuse polyposis, intestinal bleeding, lymphangiectasia and inflammatory bowel disease. Image interpretation was made by experienced capsule users, previously trained on small bowel capsule and first generation colon capsule. Lesions or abnormal changes of the mucosa identified on capsule endoscopy served as indications for colonoscopy or esophagogastroduodenoscopy with biopsy or polypectomy if needed. RESULTS: Standard white light endoscopy was made in all children without any adverse events. Second-generation colon capsule allows diagnosing Crohn's disease in small intestine and colon, limphangiectasia of the ileum, single rectosigmoid polyp and diffuse polyposis of the colon. CONCLUSION: Second-generation colon capsule can be used as non-invasive screening method in children without serious complications, thus allowing to differentiate indications for traditional white light endoscopy, which is usually made under general anesthesia in pediatrics.
Asunto(s)
Endoscopía Capsular , Enfermedades Intestinales/diagnóstico , Adolescente , Endoscopios en Cápsulas/normas , Endoscopía Capsular/instrumentación , Endoscopía Capsular/métodos , Niño , Diseño de Equipo , Femenino , Humanos , Enfermedades Intestinales/clasificación , Masculino , Pediatría/métodos , Reproducibilidad de los ResultadosRESUMEN
The peptic ulcer of stomach and duodenum are the more often occuring complications of steroid treatment in children with chronic glomerulonephrite. Dinamic investigation has shown that the using of beta-carotin oily solution in therapy of this complications increases the efficiency of traditional treatment. It has been shown that beta-carotene administration speeds the reparation of stomach and duodenum ulcers, saves adequate serum concentration of beta-carotene and retinol. The data obtained demonstrate that beta-carotene administration in the complex therapy of chronic glomerulonephrite patient with gastroenteropathy should be recommended.
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Antiinflamatorios/efectos adversos , Antioxidantes/uso terapéutico , Úlcera Duodenal/tratamiento farmacológico , Mucosa Gástrica/efectos de los fármacos , Glomerulonefritis/tratamiento farmacológico , Prednisolona/efectos adversos , Úlcera Gástrica/tratamiento farmacológico , beta Caroteno/uso terapéutico , Administración Oral , Adolescente , Antiinflamatorios/uso terapéutico , Antioxidantes/administración & dosificación , Niño , Preescolar , Enfermedad Crónica , Dieta con Restricción de Proteínas , Úlcera Duodenal/inducido químicamente , Úlcera Duodenal/dietoterapia , Úlcera Duodenal/patología , Endoscopía , Mucosa Gástrica/patología , Glomerulonefritis/patología , Humanos , Prednisolona/uso terapéutico , Úlcera Gástrica/inducido químicamente , Úlcera Gástrica/dietoterapia , Úlcera Gástrica/patología , beta Caroteno/administración & dosificación , beta Caroteno/sangreAsunto(s)
Antiinflamatorios/administración & dosificación , Duodeno/efectos de los fármacos , Mucosa Gástrica/efectos de los fármacos , Glomerulonefritis/tratamiento farmacológico , Mucosa Intestinal/efectos de los fármacos , Metilprednisolona/administración & dosificación , Adolescente , Antiinflamatorios/efectos adversos , Niño , Preescolar , Enfermedad Crónica , Duodenitis/inducido químicamente , Duodenitis/patología , Duodeno/patología , Endoscopía , Femenino , Mucosa Gástrica/patología , Gastritis/inducido químicamente , Gastritis/patología , Humanos , Mucosa Intestinal/patología , Masculino , Metilprednisolona/efectos adversos , Factores de TiempoRESUMEN
The paper summarizes the results of clinical observations and special examinations conducted in 45 children with chronic gastroduodenitis by using combined exposure to sinusoidal modulated currents and ultrasound. The dynamics of clinical symptoms, functional status of the stomach and its adjacent gastroduodenal organs, endoscopic findings, morphological status of the gastroduodenal mucosa, gastric mucosal dissemination of Helicobacter pylori, systemic and regional humoral immunological parameters, abdominal echography indicate high therapeutical efficiency of the combined therapy as compared to that performed in controls (without physiotherapy). Mechanisms of formation of therapeutical action are clarified, differentiated indications are defined.
Asunto(s)
Duodenitis/rehabilitación , Terapia por Estimulación Eléctrica , Gastritis/rehabilitación , Terapia por Ultrasonido , Adolescente , Biopsia , Niño , Enfermedad Crónica , Terapia Combinada , Duodenitis/patología , Duodenitis/fisiopatología , Duodeno/patología , Terapia por Estimulación Eléctrica/métodos , Estudios de Evaluación como Asunto , Mucosa Gástrica/patología , Gastritis/patología , Gastritis/fisiopatología , Infecciones por Helicobacter/patología , Infecciones por Helicobacter/fisiopatología , Infecciones por Helicobacter/rehabilitación , Helicobacter pylori , Humanos , Terapia por Ultrasonido/métodosRESUMEN
Clinical and special tests have found that sinusoidal modulated currents in childhood chronic gastroduodenitis produce positive changes in clinical symptoms, secretory and motor functions of the gastroduodenal zones, endoscopic picture, gastroduodenal mucosa morphology, immunologic indices, associated diseases. The authors have developed differential indications for treatment of children with gastroduodenitis using sinusoidal modulated currents.
Asunto(s)
Duodenitis/rehabilitación , Terapia por Estimulación Eléctrica/métodos , Gastritis/rehabilitación , Adolescente , Formación de Anticuerpos , Niño , Enfermedad Crónica , Terapia Combinada , Duodenitis/diagnóstico , Terapia por Estimulación Eléctrica/instrumentación , Endoscopía del Sistema Digestivo , Mucosa Gástrica/metabolismo , Mucosa Gástrica/microbiología , Mucosa Gástrica/patología , Gastritis/diagnóstico , Helicobacter pylori/aislamiento & purificación , HumanosRESUMEN
The article discusses the results of endoscopic examination of 44 children with extrahepatic portal hypertension before and after various types of portocaval shunting. Thirteen children were also examined in the late-term postoperative periods. It was found that decompression of the portal system not only leads to rapid reduction of the esophageal varicosities but also facilitates relief from gastritis and esophagitis. An unfavorable effect of cava-mesenteric shunts on the development of the bulbo-gastric reflux was revealed. It is shown that long-term regular medical observation over these patients and their nonoperative treatment are necessary.