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Biomedical subjects

H V Maffei

Publications and source records attributed to H V Maffei.

18 recordsLinked to original sources
PubMed2000

[Constipation]

OBJECTIVE: To review current information concerning the importance, pathophysiology, clinical presentation, and treatment of chronic constipation in Pediatrics. METHODS: Bibliographic review of Medline database and articles published by the authors. RESULTS: Constipation is a common disorder in childhood. The pathophysiology of constipation involves the interaction of several factors: low-fiber diet, early weaning, painful bowel movement, fecal retention, disturbance of intestinal motility, and genetic predisposition. The clinical presentation of children with constipation is variable. Several patients present the onset of constipation during the 1st year of life; however, the medical treatment is usually initiated only after a long period. Some patients are recognized due to the presence of complications, such as soiling, abdominal pain, and urinary abnormalities. The treatment should be adapted to each patient, and includes general orientation, complete colonic emptying, maintenance treatment, and a behavioral program to regulate bowel habits. Regardless of the fact that most children present functional chronic constipation, much attention should given to the entities that constitute the differential diagnosis. Specialized evaluation and diagnostic techniques should be indicated according to the patient s individual characteristics and when the clinical evolution is not satisfactory. CONCLUSIONS: The long-term control of chronic constipation depends on the acquisition of dietary habits that provide an adequate intake of dietary fiber. It is possible that a high-fiber diet is important not only to the control of constipation, but may also reduce the risk for diet-related chronic diseases during adulthood.

Journal Article↗
PubMed1994

Gut intraepithelial lymphocyte counts in neonates, infants and children.

Intraepithelial lymphocyte (IEL) counts were histologically assessed in the jejunum, ileum and appendix of 39 neonates (0-28 days), 32 infants (1-9 months) and 13 children (1-9 years). Small intestinal mucosa samples were obtained from 73 autopsies, and from 8 surgical and 3 aspirative biopsies. IEL counts of specimens from the jejunum, ileum and appendix gave similar results in the same patient. The number of IEL counts was significantly lower in neonates for all three segments. The difference between infants and children was more marked in the jejunum than in the ileum, although this was not significant. In the appendix, there was no difference between the different age groups. Our results indicate that postnatal expansion of IEL occurs homogeneously along the gut after the neonatal period.

Appendix↗
PubMed1994

Assessment of gut intraepithelial lymphocytes during late gestation and the neonatal period.

Intraepithelial lymphocyte counts (IEL % enterocytes) were carried out in histological samples of jejunal, ileal and appendiceal mucosa of 39 neonates, aged from birth to 28 days. Correlations between IEL counts and developmental factors, namely gestational age, birth weight and intrauterine growth, as well as neonatal infections or feeding state were performed. No significant differences were observed among neonates grouped according to birth weight, intrauterine growth or neonatal infections. The pattern of feeding, however was associated with significantly higher IEL counts (p < 0.02) in the ileum in oral/enterally fed neonates than in the unfed or parenterally fed. Full-term neonates also had higher counts in the ileum (p < 0.02). In this group, oral/enterally fed neonates had the higher values. Thus, besides in utero development, the pattern of feeding might be considered as an important modulating factor on IEL postnatal expansion.

Antigens↗
PubMed1990

Nutritional management and weight changes during hospitalization of Brazilian infants with diarrhoea: primary reliance on oral feeding or continuous nasogastric drip with locally made, modulated minced chicken formula.

The nutritional management of infants admitted with diarrhoea to the University Hospital of Botucatu includes a change from bolus feeding of a modulated minced-chicken formula to a continuous nasogastric drip (NGD) feeding, whenever the required calorie intake is not achieved or the diarrhoea does not subside. To evaluate this approach, the clinical course and weight changes of 63 children, aged 1-20 months, were reviewed; most (81 per cent) were below the third percentile for weight at admission and 76 per cent had a total duration of diarrhoea greater than or equal to 10 days. Associated infections, mainly systemic, were present at or after admission in 70 per cent of them. Twenty-five survivors needed nutritional support (NS), predominantly NGD, for a median duration of 30 per cent of their admission time, and were compared to 31 survivors managed without NS. Those who necessitated NS lost weight for a significantly longer median time (12 x 4 days, p less than 0.005), but their total weight loss was similar (5 x 4 per cent) as well as diarrhoea's duration (8 x 7 days). There was a tendency for a longer hospitalization (21 x 16 days 0.05 less than P less than 0.10) and a longer span to begin weight gain after diarrhoea's end for the group with NS (p less than 0.05), but subsequent growth quotient and daily weight gain during admission were similar for both groups. Both groups of survivors received similar amounts of energy, although the initial increase was delayed for those who needed the NGD.(ABSTRACT TRUNCATED AT 250 WORDS)

Brazil↗
PubMed1980

Intraepithelial lymphocytes in the jejunal mucosa of malnourished rats.

Intraepithelial lymphocytes (IEL) have been counted in the jejunal mucosa of adult Wistar rats submitted to a protein-free diet for 84 days and of a control group receiving a 20% casein diet, in order to evaluate the effect of protein deprivation. Relative counts (IEL/100 epithelial cells), absolute counts (number of IEL per millimetre of muscularis mucosae), and the proportion of lymphocytes crossing the basement membrane have been evaluated. Both relative and absolute IEL counts were diminished but the proportion of crossing lymphocytes was greatly increased in the malnourished group. The low number of IEL seemed to be related to lymphatic vessel dilatation in the lamina propria. The possibly primary effect of malnutrition on IEL counts in our experimental model and the eventual role of the observed lymphatic dilatation have been discussed.

Animals↗
PubMed1979

Histopathologic changes and the immune response within the jejunal mucosa in infants and children.

Jejunal biopsies obtained from 45 children referred for a variety of clinical conditions were examined histologically and by standard immunofluorescence methods. The number of plasma cells was recorded per "mucosal tissue unit". The results showed that most of the immunoglobulin A (IgA) counts in infants under 3 yr with normal mucosa were low and that there was a rise in the number of IgA plasma cells starting after this age. Despite this, under pathologic conditions (partial villous atrophy with increased inflammatory cell infiltration--PVA) a significant rise in IgA plasma cells occurred in all age groups. Patients with coeliac disease tended to show the highest IgA as well as IgM plasma cell counts. In all other patients, IgM counts did not change significantly with age or histologic abnormalities.

Adolescent↗
PubMed1975

Gastric pH and microflora of normal and diarrhoeic infants.

The microflora and pH of gastric contents were determined in breast-fed and in bottle-fed normal infants, in well nourished infants with acute diarrhoea and in infants with chronic diarrhoea and protein-calorie malnutrition. The last group of infants was reevaluated after recovery from diarrhoea and protein-calorie malnutrition. A bactericidal pH effect below 2-5 was observed. Bottle-fed controls had low pH values and low bacterial concentrations, whereas infants with chronic diarrhoea and protein-calorie malnutrition had high pH values and bacterial overgrowth, essentially of Gram-negative bacilli. After recovery, the only remaining alteration was the frequent isolation of yeast-like fungi in low concentrations. Infants with acute diarrhoea, except for the isolation more frequently of yeast-like fungi, presented no alterations; this seems to indicate that pH alterations and Gram-negative bacilli overgrowth occurred during the evolution of the disease to a chronic state. Breast-fed normal infants had hydrogen-ion concentrations similar to those of the chronic diarrhoea group, but without Gram-negative bacilli overgrowth, suggesting that other factors, besides pH, regulate bacterial growth in the gastric contents of these groups of infants.

Acute Disease↗
PubMedDate not supplied

[Prevalence of constipation in school children].

OBJECTIVE: To obtain the prevalence of constipation in school children, as chronic constipation is frequent among children attending our outpatient unit but only scarce data about community prevalence are available. METHODS: 1145 children of the two first school years (52.5% males, median age 8y 4mo) of 5 schools in underprivileged areas were evaluated. They answered a previously validated questionnaire, applied by specially trained students of a practical nurse school. Defecation of scybalous stools and/or straining / pain, usually, were used to characterize constipation, by a strict criterium. Soiling or fecal blood occurring as isolated symptoms were not included in the strict criterium, but were included in two other criteria. RESULTS: The prevalence of constipation was 25.1% for boys and 32.9% for girls, by the strict criterium, and was more frequent among girls (p<0.05). Constipated boys and girls presented, respectively, 30.5% e 31.8% of soiling and 14.6% and 25.7% of fecal blood. In addition 61 boys and 49 girls presented either soiling or fecal blood as isolated symptoms and increased the prevalence by the other criteria. CONCLUSIONS: The prevalence of constipation in the observed community was high. Due to the severity of the possible complications, this could be considered a public health problem.

English Abstract↗
PubMedDate not supplied

[Anthropometric evolution during hospitalization of severe malnourished children with persistent diarrhea receiving standardized nutritional support].

In order to estimate the nutritional rehabilitation (NR) during admission of malnourished children with persistent diarrhea (PD) receiving standardized nutritional support (NS), we prospectively evaluated the weight, height, head circumference and arm measurements (AM) of 20 children, 19 below 1 year, admitted to the ward with weigh/age -2.89 to -5.21 standard deviation. Four infants comprised the death group (DG) and 16 survived (SG). The SG was separated, according to initial weight behavior, into weight gain (WG) or weight loss (WL). Compared to SG at admission, DG only had lower AM and more metabolic-infectious alterations (p<05). The survivors presented NR but this was evident for WL only when considering the minimum weight. DG received less calories than SG and weight loss during the pre-death period was higher than for WL (p<05). It was concluded that very altered AM, severe metabolic-infectious insults, low caloric input and high weight loss velocity are associated to bad prognosis; severely malnourished infants with PD began NR during hospitalization while receiving adequate NS, but minimum weight must be considered for this evaluation; AM must be obtained at admission, due to its prognostic value, and adequate NS as well as anthropometric follow-up during the hospital stay are essential.

English Abstract↗
PubMedDate not supplied

[Clinical and alimentary history of children attending a pediatric gastroenterology outpatient clinic with functional chronic constipation and its possible complications].

In order to better understand the natural history of chronic functional constipation, a questionnaire was applied to 163 children and infants, before beginning standardized treatment. Median age (range) at start was 3 mo(0-108 mo) but age at arrival at the Pediatric Gastroenterology Unit was 53 mo(2-146 mo). In 62.4% of the cases symptoms began before or up to 3 mo after cow's milk introduction and rarely around (-/+ 6 mo) toilet training. Possible complications appeared progressively, often at preschool or school age or as the first noticeable manifestation: recurrent abdominal pain (61.1%), fecal soiling (45.4%), fecal blood (35%), enuresis (23.3%), vomiting (19%), urinary infection (17.9%), urinary retention (8.6%). Abdominal distension was rarely detected on physical examination and was usually discrete. In conclusion, children attended in Botucatu begin their constipation at an early age, frequently associated with weaning,and important complications may ensue along years. This evolution should be avoided by prevention and early treatment of constipation.

English Abstract↗
PubMedDate not supplied

[The fat absorption test in children].

To overcome the difficulties observed with fecal fat estimations, we studied fat absorption in 4 m to 12 years old children, assessing increments of serum triglycerides after administration of corn oil. Eighteen well-nourished children without gastrointestinal symptoms or parasites, 31 children with protein-calorie malnutrition (PCM), with or without protracted diarrhea and/or intestinal parasites and nine children with specific malabsorptive entities were studied. Serum triglycerides (TG) were measured before, 2 and 4 hours after the administration of 2 g/kg of corn oil per os. For control infants below 2 years no significant differences between the fasting level and those after 2 and 4 hours were observed. For children above this age significant absorption occurred by 2 hours but more intensively after 4 hours, an increment of TG above 35 mg% being considered normal. A good discrimination between TG increments of controls and malabsorptive children over 2 years was observed. In conclusion, the oral fat loading test, is applicable for children over 2 year of age. For infants below this age other schedules should be tested.

Child↗
PubMedDate not supplied

Carbohydrate malabsorption in infants with diarrhea: diagnostic and evolutive aspects.

Twenty three infants with acute or protracted diarrhea were investigated for carbohydrate (CHO) malabsorption during their normal feeding schedules. All infants were fed a chicken-meat formula which contained rice flour and maltodextrin. End-tidal respiratory H2 concentrations were sequentially evaluated in different clinical settings and compared to fecal pH and reducing substances. Fecal pH below 6.0 and/or breath H2 greater than 25 ppm were considered evidence of CHO malabsorption, as these values disappeared while infants were submitted to a trial of CHO withdrawal per os, reappearing after CHO reintroduction. Values of fecal pH greater than 6.0 most often (84,2%) occurred along with H2 less than 25 ppm, thus frequently reflecting a good CHO absorption. pH values below 6.0, however, although reflecting CHO malabsorption, did not predict the presence of significant H2 concentrations in expired air. In 44.4% of the well-nourished or only mildly malnourished infants some evidence of CHO malabsorption was present, whereas this occurred in all severely malnourished infants. This last group of infants had a longer history of diarrhea prior to admission and needed a longer hospitalization. The frequency of H2 values greater than 25 ppm decreased progressively during the clinical evolution, along with an increase in CHO ingestion, findings possibly related to nutritional improvement. The hydrogen breath test and fecal pH allowed the diagnosis of CHO fermentation when applied as in this study, without a conventional CHO overload and without previous fasting. It did, however, not predict clinical intolerance, as signs of CHO malabsorption still occurred in infants whose diarrhea had already subsided.

Breath Tests↗
PubMedDate not supplied

[Retrospective study in hepatic biopsies, of hepatitis B surface antigen by the orcein method and indirect immunofluorescence methods].

A retrospective study of the HBsAg was done in 56 liver biopsies of children less than 12 year-old and 78 biopsies of adults. The study was performed by orcein stain and indirect immunofluorescent method. In 23 of the adults patients, the serological detection of HBsAg and antibodies (HbsAb) was determined by reverse passive haemagglutination technique. The adults patients' histological dianosis were variable and included acute or chronic hepatitis (20.5%) and cirrhosis (24.4%). Orcein was positive in 7 and IFI in 6 cases; 5 biopsies were positive by both methods. The highest incidence of HBsAg was seen in active cirrhosis (75%), including two cases of alcoholic cirrhosis. In the 23 serologically studied patients, 15 cases were HBsAg negative and 3 were HBsAg positive both in the liver and serum; only 2 cases showed discrepancy between these results. Three patients were HBsAb positive and HBsAg negative both in the liver and serum. All children biopsies were HBsAg negative. Among these patients, 26.8% had acute or chronic hepatitis and 10.7% cirrhosis. Serological and tissue techniques for HBsAg and HbsAb detection have different sensitivity. This should be kept in mind when studying the incidence of hepatitis B virus related to liver diseases.

Adult↗