Nine children and adolescents with chronic intestinal diseases and growth failure were treated with home parenteral nutrition (HPN) for 7-63 months. All patients improved their growth velocities on HPN, with an average height gain of 9 cm. The mean growth velocity in six patients with Crohn's disease increased more than fivefold (from 0.67 +/- 0.4 cm/year to 3.8 +/- 1.09 cm/year), and they gained a mean of 11.4 +/- 3.4 kg/year. The three patients without Crohn's disease [intestinal pseudo-obstruction (two), severe short bowel (one)] increased growth velocity from an average of 2.9 +/- 1.1 cm to 6.1 +/- 1.34 cm/year and gained a mean of 10 +/- 2.84 kg/year. Patients without Crohn's disease grew faster on HPN than age comparable patients with Crohn's disease. Also, the two patients with Crohn's disease who were younger and had their disease for a shorter period (less than 3 years) grew better than older patients with Crohn's disease who had their disease for a mean of 8 +/- 1.3 years. All patients improved clinically, and three with Crohn's disease achieved complete remission. Five of the nine patients had psychosocial adjustment problems while on HPN. In conclusion, HPN is a relatively safe and effective means to stimulate growth in children and adolescents who cannot meet nutritional needs by the enteral route.

Adolescent↗

PubMedDate not supplied

The endorectal pull-through procedure in children and young adults: a follow-up study.

At our institution, proctocolectomy with rectal mucosectomy and ileoanal anastomosis with endorectal pull-through is now the procedure of choice for young patients with chronic ulcerative colitis and familial polyposis. We have followed up 66 patients (37 male and 29 female, with a median age of 16 years) for at least 6 months after closure of the temporary ileostomy. The patients were seen regularly in follow-up or were sent a comprehensive questionnaire to assess their condition. Twenty-two patients had the construction of a J-pouch, and 44 had a straight ileo-anal pull-through. Stool frequency, day (median 4 to 7 stools) and night (median 1 to 3 stools), was similar in the two groups. Voluntary continence was excellent in both groups during waking hours. Occasional night-time incontinence in small volumes, mild perianal itching, and minimal bleeding from irritation were similar in both groups. Most of the patients could distinguish gas from stool. When medication was used, bulk agents were usually chosen, with a nonspecific antidiarrheal agent taken occasionally. A few patients with the straight ileo-anal pull-through expressed some dissatisfaction early during the follow-up period; however, all but two patients expressed satisfaction later. Of the 66 patients, 41 had at least one complication during the postoperative period; however, in 26 the complications were minor. The more severe complications included small bowel obstruction (11 patients requiring surgical decompression), infection (one patient requiring surgery), and transient neuropathy (three patients).

Adenomatous Polyposis Coli↗

PubMedDate not supplied

A new approach for quality of life assessment in cardiac patients: rationale and validation of the Quality of Life Systemic Inventory.

OBJECTIVE: To validate an interview-like questionnaire measuring quality of life, based on the subject's capacity to reach personal goals in different life domains. DESIGN: One group repeated measures for test-retest reliability (two-week interval) and correlational approach for concurrent validity. PARTICIPANTS: A total of 171 normal subjects (95 males and 76 females) was interviewed. Mean age was 43.6 years. OUTCOME MEASURES: The Quality of Life Systemic Inventory (QLSI), the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Marlowe and Crowne Social Desirability Scale, the Buss and Durkee Hostility Inventory, the Carver and Sheerer self-efficacy scale and the Derogatis Stress Profile were used. RESULTS: The quality of life score (a gap score representing the difference between a subject's actual state and personal goal) has a high test-retest reliability of 0.838. The two other scores (goal and potential for conflict) also have good test-retest reliability: 0.858 for both. Intercorrelations between scores are low-gap-goal, 0.293; gap-conflict, 0.172; and goal-conflict, 0.115--suggesting their distinctiveness. Correlations between scores and social desirability are also low-gap, 0.106; conflict, -0.024; and goal, -0.128. Finally, correlations with other psychological variables such as depression, anxiety, self-efficacy and stress are moderate to low, showing that the questionnaire measures dimensions different from these variables. CONCLUSIONS: The QLSI has good test-retest reliability, and scores are not much influenced by social desirability despite the fact that the test is used in an interview setting. The questionnaire may be administered in small groups or face-to-face situations. It yields a wealth of clinical information and is easily used in research. Furthermore, patients much prefer this interactive exchange to the long self-administered questionnaires.

Adult↗