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P Mamula

Publications and source records attributed to P Mamula.

5 recordsLinked to original sources
PubMed2005

Success rate and duration of paediatric outpatient colonoscopy.

BACKGROUND: The paediatric colonoscopy completion rates have rarely been reported. AIMS: We sought to evaluate colonoscopy completion rate and compare the rates using colonoscope versus enteroscope. METHODS: We prospectively investigated 60 patients who underwent colonoscopy between July 1999 and June 2001. The following data were collected: demographics, type of endoscope used, extent of colonoscopy, indication for procedure, histology, adverse events and time to reach the caecum and the terminal ileum. RESULTS: Sixty colonoscopies were performed during the study period, 30 with an enteroscope and 30 with a colonoscope. The caecum was reached in 56/60 (93%) and the terminal ileum in 50/60 (83%). An average time of 12.61 min (S.D. 7.3) was necessary to advance the instrument from the anus to the caecum, and additional 3.67 min (S.D. 3.62) to terminal ileum. There was no difference in the success rate between enteroscope and colonoscope. Six patients (10%) had definitive diagnosis established because a full colonoscopy was performed. No serious adverse events occurred. CONCLUSION: Paediatric colonoscopy to the caecum can be completed safely and expeditiously in more than 90% of procedures. Various types of instruments do not appear to influence completion rate. Full colonoscopy contributes to the establishment of a definitive diagnosis.

Adolescent↗
PubMed2005

Extraintestinal manifestations of inflammatory bowel disease.

Inflammatory bowel disease (IBD) predominantly affects the gastrointestinal system but it is associated with a large number of extraintestinal manifestations (EIM). These extraintestinal disorders can significantly contribute to morbidity and impair the overall life quality. EIM may be diagnosed before, concurrently with, or after the diagnosis of IBD is made. The precise etiology of EIM remains unknown. It currently is believed that mucosa from the underlying bowel disease may provide associated immune responses for the inflammatory process in the extraintestinal sites. The involvement of autoimmune mechanisms has been suggested when the shared and unique epitopes in the human colon, eye, joint and biliary epithelium were detected. Recently, the presence of long-lived populations of memory lymphocytes has been discovered which arise as a consequence of bowel inflammation and express homing receptors that direct their migration not only to the gut but also to the extraintestinal sites. The most common extraintestinal disorders associated with IBD include dermatologic, ophthalmologic, musculoskeletal and hepatobiliary diseases, although virtually every organ system may be involved. If these disorders can be considered as the real extraintestinal manifestations of IBD or represent just association between different syndromes of autoimmune etiology, is still not clear. It is important to acquire knowledge on these extraintestinal manifestations of Crohn's disease and ulcerative colitis to start the respective treatment early.

Biliary Tract Diseases↗
PubMed2001

Failure of single-toxin assays to detect clostridium difficile infection in pediatric inflammatory bowel disease.

OBJECTIVES: The aims of this retrospective study were 1) to determine the ability of single-toxin assays for Clostridium difficile to detect infection among pediatric patients with inflammatory bowel disease (IBD) and 2) to determine the toxin assays routinely used by pediatric tertiary care hospitals in the United States. METHODS: Stool specimens from patients with IBD (submitted from January, 1996, to August, 1999) were evaluated for the presence of C. difficile toxin A and toxin B. Toxin profile (toxin A alone, toxin B alone, toxin A and B together) was compared in positive specimens. A phone interview was conducted with representatives from laboratories in 22 pediatric hospitals to investigate which toxin assays were routinely used. RESULTS: A total of 697 specimens were submitted from 284 IBD patients. In all, 81 IBD patients (28.5%) had at least one documented infection. Toxin A assay failed to identify 41.5% of C. difficile infections. Toxin B assay failed to detect 34.9% of C. difficile infections. Toxin profile changed in 55% of patients with multiple infections. Of the hospitals surveyed, 59% did not test for both toxins. CONCLUSIONS: Single-toxin assays for C. difficile fail to detect a significant percentage of infections. The toxins identified during one infection are not predictive of the toxins identified in subsequent infections. Despite this, many pediatric hospitals do not routinely use both toxin assays to diagnose C. difficile infection. When infection is suspected, assays for C. difficile toxin A and toxin B should be requested.

Adolescent↗