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Original Article
Abdominal tuberculosis in children Report of 10 casesPrice: €10,00 |
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Background : Abdominal tuberculosis is a rare location of this
infection with a lot of diagnostic difficulties. The aim of this study
was to review our experience of pediatric abdominal tuberculosis
with that of the literature data.
Patients and methods : A retrospective study was conducted over
a 7- year period ; 10 cases of abdominal tuberculosis in children
were reviewed (6 girls and 4 boys, mean age : 11 years, extremes
4-14). Eight patients enrolled in this study satisfied the following
criteria : a positive culture for mycobacterium tuberculosis on
samples of ascites fluid, sputum, urine, abscess puncture and/or
caseating granulomas on histologic examination of biopsies
obtained by endoscopy, percutaneous aspiration or needle biopsy
or exploratory laparotomy. Two other patients (patients N° 1 & 5)
had a favorable response within 10 weeks of antituberculous therapy.
Results : We observed 8 cases of peritoneal tuberculosis and
2 cases of intestinal tuberculosis. Extra-abdominal tuberculosis
was found in 4 of those patients. Two patients had a contact with a
tuberculosis positive individual. Nine children had BCG immunization.
The main clinical features were abdominal distension (6 cases)
and abdominal pain (6 cases). Abdominal ultrasonography visualized
mesenteric lymphadenopathies (6 cases), an abdominal mass
(5 cases), free (1 case) and localized ascites (1 case). Barium
enema and small bowell series showed small bowel stenosis (1 case)
and ileal ulcerations (1 case).
Exploratory laparotomy, performed in 3 patients, showed
whitish granulations and peritoneal abscesses with caseous necrosis
on histology. Quadruple therapy with tuberculostatic agents
was prescribed in all patients, associating isoniazid, rifampicin,
pyrazinamide combined at the start of the treatment with streptomycin
(7 cases) and ethambutol (3 cases). Short term outcome was
favorable with no deaths. The long term outcome was complicated
by persistent ascites (1 case) and the development of portal
hypertension (1 case).
Conclusion : Abdominal tuberculosis remains a rare localization
with a lot of diagnostic difficulties. [Product Details...] |
Percutaneous endoscopic gastrostomy in cystic fibrosis : patient acceptance and effect of overnight tube feeding on nutritional statusPrice: €10,00 |
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Background : Malnutrition remains a common problem in cystic
fibrosis (CF) patients, despite pancreatic enzymes and hypercaloric
diet advice. When oral supplementation fails, additional
overnight gastrostomy tube-feeding is a therapeutic option.
Methods : In our centre gastrostomy tube feeding is proposed
when weight for height drops below 85% despite intensive dietetic
counselling. All the CF patients at our centre (n = 11) receiving
gastrostomy tube feeding were evaluated for changes in nutritional
status and pulmonary function. Complications of percutaneous
endoscopic gastrostomy were inventarised and patients older than
7 years and all the parents were asked to fill in a questionnaire
concerning subjective well-being with gastrostomy supplemental
feeding.
Results : The patients received 40% of the recommended daily
allowances (RDA) for energy by tube feeding. Total daily energy
intake increased by 30%. Within 3 months this resulted in a significant
improvement in nutritional status expressed as percentage
of ideal weight for height or body mass index z-score. After
6 months a significant catch-up growth was detectable. Pulmonary
function remained stable. The complications were local irritation
(n = 4), night sweating (n = 1) and bed-wetting (n = 1). The gastrostomy
was well accepted.
Conclusion : Gastrostomy appears to be a good and safe way to
improve nutritional status, growth and mood of the CF child. As
decreased pulmonary function plays a crucial role in the growth of
the CF child, full normalisation of growth pattern is not achieved
despite catch-up. Gastrostomy tube feeding should perhaps be
used earlier to optimalise growth. [Product Details...] |
Perioperative immunonutrition ameliorates the postoperative immune depression in patients with gastrointestinal system cancer (prospective clinical study in 42 patients)Price: €10,00 |
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Cancer surgery is a major challenge for patients to develop
immune depression in postoperative period. Several cytokines can
depress immune cell subpopulations. Increased cytokine response
after surgery is assumed to arise mainly from lipooxygenase pathway
acting on membrane arachidonic acid. Therefore ; investigators
focused their efforts to alter the membrane fatty acid profile
by changing the nutritional regimen with e-3 fatty acid supplementation
and encouraging results were obtained after surgery.
Despite the theoretical and clinical advantage of enteral nutrition
many surgeons remain committed to parenteral nutrition for feeding
of patients due to maintain bowel rest and fear of anastomosis
leakage at the postoperative period. Several studies investigating
role of the postoperative immunonutrition reported that beneficial
immunological changes were associated with reduction of infectious
complications. Interestingly ; these findings were observed at
least five days after the surgery in which the highest incidence of
complications was seen. In this prospective study including
42 patients eligible for curative gastric or colon cancer surgery ;
we investigated the beneficial effect of enteral immunonutrition
(EEN) compared to total parenteral hyperalimentation (TPN)
beginning from the preoperative period. Cortisol and CRP levels
as stress parameters significantly increased one day after surgery
in both groups but they rapidly returned to (on POD1) preoperative
baseline level in EEN group whereas these values remained
high in the TPN group. Additionally a significant decrease in natural
killer (NK) cells and CD8+ levels were observed in both
groups. However they recovered on POD3 in EEN group and on
POD6 in TPN group. CD4+ subset remained almost same as preoperative
value in the TPN group whereas it increased from (%)
40.14 to 46.40, 51.29 and 54.7 on PO 6th hr, POD3 and POD6 in the
EEN group. Our findings suggest that preoperative nutrition via
the enteral route provided better regulation of postoperative
immune system restoration than parenteral nutrition. On the basis
of our findings we recommend enteral immunonutrition to be
started at the preoperative period rather than postoperatively
before a major operation whenever the enteral route is feasible. [Product Details...] |
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Acta Gastro-Enterologica Belgica is indexed in NCBI/PubMed.
Printed by Universa Press, Wetteren, Belgium. ©vzw/asbl Acta Gastro-Enterologica Belgica
Printed by Universa Press, Wetteren, Belgium. ©vzw/asbl Acta Gastro-Enterologica Belgica