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Biomedical subjects

V Tolia

Publications and source records attributed to V Tolia.

At least 37 records · Page 2Linked to original sources
PubMed1999

Flumazenil in children after esophagogastroduodenoscopy.

OBJECTIVE: Our aim was to evaluate if the routine use of the benzodiazepine antagonist flumazenil would shorten postprocedure recovery times after esophagogastroduodenoscopy in pediatric patients receiving standard intravenous conscious sedation with the benzodiazepine diazepam in combination with meperidine. METHODS: Upper endoscopy was performed using intravenous conscious sedation with standardized doses of diazepam and meperidine on 29 children, age range 6-18 yr. Patients were randomized in a double-blind fashion to receive either intravenous normal saline (placebo) or 0.01 mg/kg (maximum, 1.0 mg) flumazenil within 5 min of procedure completion. Evaluation of the degree of sedation using a modified Observer' s Assessment of Alertness/Sedation Scale was performed presedation, immediately before reversal solution administration, and serially over 60 min after reversal solution injection. RESULTS: Fifteen patients received flumazenil and 14 received placebo; patient group composition did not vary significantly in age and weight. Fifty-four percent of flumazenil patients and 30% of control patients achieved full alertness within 10 min of reversal solution injection. However, this difference between groups was not significant (p > 0.45). Resedation or side effects directly attributable to flumazenil were not observed. CONCLUSIONS: A single postsedation dose of flumazenil is well-tolerated in children >6 yr old. However, its routine use after esophagogastroduodenoscopy is of questionable benefit in shortening recovery time in this age group.

Adolescent↗
PubMed1999

A randomized, prospective study to evaluate the efficacy and acceptance of three bowel preparations for colonoscopy in children.

OBJECTIVE: We performed a prospective, randomized, single-blind study in children undergoing colonoscopy to evaluate the acceptance and efficacy of three different bowel preparations. METHODS: Seventy patients (ages 3-20 yr, 38 males) were randomly assigned to one of the three study preparations: Magnesium citrate with X-prep and clear liquid diet for 2 days (group A); Dulcolax for 2 days and Fleet enema without dietary restriction (group B); and Golytely 20 ml/kg (up to 1 L) per hour for 4 h with clear liquid diet for 1 day (group C). Endoscopists blinded to bowel preparation graded the adequacy of colon cleansing. The preparations were rated by patients for tolerance, willingness to retake them, adverse effects, and compliance. RESULTS: Data analysis using Fisher exact test and trend test showed that colon cleansing in groups A and C was superior to that in group B (p < 0.0001) and better in group C than A (p < 0.075). Overall tolerance and compliance were significantly better for groups A and B than group C (p < 0.003), but not different between A and B. More of group B patients were willing to retake the preparation than in group C (p < 0.002) and group A (p < 0.05), but this was not different between groups A and C. Adverse effects were reported more frequently by patients in group C than in groups A and B (p < 0.01). CONCLUSIONS: Although the least well tolerated, Golytely provided the best cleansing. Dulcolax without dietary restriction provided unsatisfactory colon cleansing. Magnesium citrate with X-prep was acceptable and provided good cleansing.

Adolescent↗
PubMed1998

Early weaning induces jejunal ornithine decarboxylase and cell proliferation in neonatal rats.

Increased ornithine decarboxylase (ODC) activity is associated with rapid cell proliferation in many cell types. The cellular effects of early weaning on intestinal development are not well established. To investigate whether ODC is involved in intestinal growth after early weaning, we precociously weaned suckling rats on postnatal d 15 and followed through d 21 (6 d after early weaning). Age-matched suckling pups served as controls. Rat pups were killed 1, 2, 3 and 6 d after early weaning and jejunal mucosa was assayed for ODC and sucrase activities, and protein and DNA contents. Jejunal cell proliferation was monitored by bromodeoxyuridine immunohistochemistry. Elevated jejunal ODC activity 1 d after early weaning was the earliest cellular event that was detected in the current study. ODC activity peaked at d 3 (about 15-fold greater than age-matched unweaned suckling controls). Sucrase activity was elevated at d 2 after weaning and peaked at d 3 (about 10-fold greater than controls). Greater bromodeoxyuridine immunostaining in early weaned rats occurred on d 3. Protein and DNA contents were greater in jejunal mucosa of early weaned rats at d 6. Serum corticosterone levels were elevated on d 1 and d 2 after early weaning compared to controls. To explore whether the intake of nonpurified diet played a role, we also compared the induction of jejunal ODC activity in early weaned pups and pups that were food-deprived for 1 d. ODC activity was not greater in the food-deprived group compared to suckling controls while the early weaned group had 6-fold greater activity 1 d after early weaning. Early weaning stimulates jejunal cell proliferation and differentiation. The temporal sequence of increased ODC activity followed by increases in other growth variables suggests that the induction of ODC activity may act as an early marker of intestinal growth during early weaning.

Age Factors↗
PubMed1998

Colonic polyps in children: frequently multiple and recurrent.

A retrospective chart review on 77 children and adolescents (45 males and 32 females) with colorectal polyps seen over a 15-year period (1980-1994) was undertaken. Their presenting symptoms, demographic data, methods of diagnosis, pathologic diagnosis, and outcome were assessed. The age at presentation varied from 6 months to 19 years (mean age 77 months), 66.2% presenting under 6 years of age. The presenting symptoms were rectal bleeding in 71 patients, mass per rectum in 12, abdominal pain in nine, diarrhea in nine, vomiting in two, and one patient was asymptomatic. Air contrast barium enema was confirmatory in 41/54 patients (76%). Polyps were palpable in 16 patients during the rectal examination. A single polyp was present in 50 patients, whereas two to five polyps were present in 20 patients, and more than five in seven patients. Successful endoscopic removal was accomplished in 71/73 patients (97.3%). In 83.1% of patients polyps were located in the rectosigmoid area and in 32.5% polyps occurred proximal to the sigmoid colon. However, multiple polyps in the same location or at other locations were also present simultaneously. Recurrence was observed in five of 63 patients (7.9%) with juvenile polyps, in one patient with infantile polyposis, and in one with solitary adenomatous polyp. We conclude that a full colonoscopic evaluation should be performed in all patients with suspected polyps if feasible, for multiple polyps occurred in 35% of children without polyposis syndromes in this series. Parents of patients with more than three polyps and/or a family history of juvenile polyposis should be warned regarding the possibility of an increased risk of malignancy in future if polyps continue to recur.

Adolescent↗
PubMed1997

Gastrointestinal tolerance of a pediatric fiber formula in developmentally disabled children.

OBJECTIVE: We performed a masked, randomized, 2-month crossover study with developmentally disabled children to study the tolerance of a pediatric adapted enteral formula with added soy fiber. METHODS: Twenty children and adolescents aged 1 to 17 years, requiring liquid nutrition, were fed Pediasure (PS) and Pediasure with approximately 10 g total dietary fiber/l, (PSF10) as their major source of energy and nutrient intake for 1 month each. During the two 4-week periods of the crossover study, intake, tolerance of the formula, and stool characteristics were monitored daily with diaries. Criteria for gastrointestinal tolerance were symptoms of emesis, gas, irritability or fussiness. Stool characteristics included frequency, consistency, and the need to use elimination aids to induce defecation. Following completion of the crossover study, the patients were fed PSF10 for an additional 2 months. Anthropometrics were obtained at study initiation and at each biweekly visit during the crossover phase and monthly during the follow-up phase. Bowel scintigraphy studies were conducted in patients with oral or nasogastric intake during the crossover periods. Biochemical assessments were conducted at entry, at the end of each crossover period, and at exit. RESULTS: There were no differences in any of the tolerance, stooling, growth, or biochemical measurements between the feeding regimens, in 11 children completing this phase of the study. However, there was a trend towards using less elimination aids to induce a bowel movement during the fiber supplemented formula phase. CONCLUSIONS: Pediasure with fiber is well tolerated in children with developmental disabilities.

Adolescent↗
PubMed1997

Adolescents with inflammatory bowel disease: the roles of negative affectivity and hostility in subjective versus objective health.

Examination of how psychological factors relate to illness severity among adolescents with inflammatory bowel disease (IBD) is rare. Further, studies have not accounted for the pervasive influence of negative affectivity (NA) or distinguished among subjective, behavioral, and objective measures of IBD severity. We examined how NA, positive affectivity, expressed hostility, and negative life events were related to subjective (pain, fatigue, disability), behavioral (health care contacts), and objective (erythrocyte sedimentation rate) illness severity among 56 adolescents with IBD. NA was positively related to subjective illness, and expressed hostility was inversely related to objective illness. Other relationships were eliminated after controlling for NA. Data suggest that NA and subjective illness are comanifestations of a single disposition, but that expressed hostility has an independent relationship with disease activity among adolescents with IBD.

Adaptation, Psychological↗
PubMed1997

Gynecomastia with metoclopramide use in pediatric patients.

Gynecomastia and galactorrhea stemming from hyperprolactinemia have been reported in adults after the use of metoclopramide. We describe the cases of an adolescent with gynecomastia and an infant with gynecomastia and galactorrhea that were the result of metoclopramide therapy for gastroesophageal reflux disease.

Adolescent↗
PubMed1997

Experience with gastrojejunal feeding tubes in children.

OBJECTIVE: Assessment of untoward symptomatic outcomes and major/minor complications occurring in children with percutaneous gastrojejunal tubes (GJT) in place. METHODS: A retrospective chart review of 28 patients with GJTs was performed. The diagnoses for these patients were: neurological diseases, 23; respiratory diseases, two; and gastrointestinal tract disorders, three. Twenty-three tubes were placed radiologically, four endoscopically, and one surgically. Patients' age range was between 1.5 and 180 months (mean 47.2 months), and weight at the time of tube insertion was between 2.28 and 42.7 kg. (mean 11.7 kg.). Duration of follow-up was from 1 to 49 months (mean 17.3 months). The patients were evaluated for the persistence or new development of the following symptoms: vomiting, hematemesis, abdominal pain, constipation, diarrhea, pain at the site of gastrostomy tube insertion, stridor with feeds, and dumping. Minor complications (including breakage, partial/total displacement, or dislodgement of GJT, tube occlusion, tube leakage, transient infection and/or granuloma at the gastrostomy site, and continued gastroesophageal reflux post-GJT conversion), as well as major complications (requiring surgical intervention) and mortality, were assessed. RESULTS: One or more symptoms either persisted or developed de novo in 20 children after tube insertion. Vomiting was the most common symptom, being present in 16 patients. One or more minor complication occurred in 21 patients; the most common was the accidental dislodgement of the jejunal feeding catheter. Major complications occurred in 11 patients (e.g., fundoplication in seven patients). Five patients died. Six patients had no complications; at the time of GJT placement, their mean age (93.3 months) was significantly older (p = 0.0269) and mean weight (21.3 kg.) significantly heavier (p = 0.0067) than those of children reporting major complications. CONCLUSIONS: We conclude that ongoing or new gastrointestinal symptoms and minor complications are common in children with GJT. However, GJT placement in larger children is associated with fewer complications than in smaller children.

Abdominal Pain↗
PubMed1997

Annular pancreas.

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Anastomosis, Surgical↗
PubMed1996

Molecular analysis of the fructose transporter gene (GLUT5) in isolated fructose malabsorption.

Fructose, a naturally occurring monosaccharide, is increasingly used as an added sweetener in processed foods in the form of high fructose corn syrup. Increased fructose intake combined with the identification of children with clinical evidence of isolated fructose malabsorption (IFM) has stimulated interest in possible disorders of fructose absorption. The intestinal absorption of fructose is carried out by the facilitative hexose transporter, which has been designated as GLUT5. Functional properties and tissue distribution of GLUT5 suggest that IFM might be due to mutations in the GLUT5 gene. To test this hypothesis, we screened the GLUT5 gene for mutations in a group of eight patients with IFM and in one subject with global malabsorption, as compared with 15 healthy parents of subjects and up to 6 unrelated controls. No mutations were found in the protein coding region of this gene in any of the subjects. A single G to A substitution in the 5' untranslated region of exon 1 was identified in the subject with global malabsorption. This subject and her healthy mother were heterozygous for the variant sequence, suggesting that it was unlikely to be clinically significant. In addition, sequence analysis of each of the 12 GLUT5 exons was performed in the index case and confirmed the negative single-strand conformation polymorphism findings. These studies demonstrate that IFM does not result from the expression of mutant GLUT5 protein.

Alleles↗
PubMed1996

Absence of bacteremia after gastrointestinal procedures in children.

BACKGROUND: Transient bacteremia after certain gastrointestinal endoscopies is well documented in adult patients; however, experience in pediatric patients is very limited. We conducted a prospective study to determine the frequency of bacteremia after common endoscopic procedures in children. METHODS: A total of 108 endoscopies were performed in 95 patients (age range 8 months to 17 years; mean age 10.2 years). Procedures included 68 esophagogastroduodenoscopies (EGDs), 29 colonoscopies, and 11 flexible sigmoidoscopies. Most procedures (88) were performed with patients under conscious sedation; 20 were under general anesthesia with endotracheal intubation. Biopsy specimens were obtained from all patients. Blood samples for aerobic and anaerobic cultures were obtained prior to, and within 5 minutes of, completion of the procedure. In patients who underwent general anesthesia, a third sample was obtained 5 minutes after endotracheal intubation and before endoscopy. RESULTS: Four of the pre-endoscopic blood cultures were positive. Two cultures were positive after endotracheal intubation, but were negative after endoscopy. Four cultures were positive after endoscopy. All organisms were skin or environmental flora and were considered contaminants. All patients with positive cultures remained asymptomatic during the 72 hours after the procedure. CONCLUSION: We conclude that clinically relevant bacteremia is very infrequent following routine endoscopic procedures with biopsies in immunocompetent children.

Adolescent↗
PubMed1996

Perianal Crohn's disease in children and adolescents.

OBJECTIVES: To review the frequency, severity, course, and outcome of perianal Crohn's disease in children and adolescents. METHODS: Records of 141 children and adolescents with Crohn's disease were reviewed. Of these, 18 patients (eight female, 10 male) between 9 and 18 yr of age (nine blacks and nine whites) had significant perianal disease. The disease was classified on the basis external appearance, degree of inflammation, presence of infection or abscess formation, spread to vulva, loss of perineal body, and occurrence of anal canal stricture as being mild, moderate, or severe. RESULTS: Eight patients had severe involvement, whereas moderate and mild degree of perianal disease was seen in six and four patients, respectively. Disease localization was as follows: pancolitis, 12; ileocolitis, four; and left colitis, two. Therapy with Azulfidine or 5-amino salicylic acid preparation, local and systemic steroids, metronidazole, immunosuppressives, and enteral and/or parenteral nutrition was used in various combinations. Surgery was necessary in eight patients: in four for management of anal canal stricture, incision and drainage of abscess in two, total proctocolectomy in one, and fecal diversion in an additional patient. Over a follow-up period ranging from 18 months to 15 yr, nine patients had partial improvement, whereas in the rest, the disease either did not improve or worsened. CONCLUSIONS: Severe, mutilating perianal Crohn's disease, causing significant tissue destruction, occurs in both sexes and is extremely refractory to treatment in the majority of patients. The outcome in mild and moderate disease is better.

Adolescent↗
PubMed1996

Outcome after surgical intervention in children with chronic inflammatory bowel disease.

A retrospective review of 32 children and adolescents (18 males and 14 females) with chronic inflammatory bowel disease (CIBD) requiring surgery was undertaken. These patients were followed between 1979 and 1992. Their age range was from 4 to 17 years at the time of diagnosis (mean age, 11 years). The interval between the time of diagnosis and surgery ranged from 2 months to 11 years (mean, 3.7 years). Ten patients had ulcerative colitis and 22 had Crohn's disease. These patients represented 12 per cent of patients with CIBD seen at the Gastroenterology Clinic of Children's Hospital of Michigan during these 13 years. Indications for surgery included failure of medical treatment (seven patients), localized disease with significant side effects of therapy (nine), partial or complete obstruction (five), growth retardation (six), perforation (two), abscess and fistula (three). The extent of disease was as follows: panenteric, 2 patients; enteric, 2 patients; ileocecal, 15 patients; and colonic, 13 patients. In 15 patients (47%) surgery led to complete relief of symptoms for a minimum of 1 year after surgery. Seven patients (22%) had recurrence of symptoms that were controlled by medical treatment. Two patients required a second surgery and additional medical and nutritional treatment. All six patients having surgery for growth retardation showed catch-up growth in weight and height. We conclude that surgery can decrease morbidity and improve quality of life in CIBD patients. Best results are obtained in patients with localized disease.

Adolescent↗
PubMed1995

Very early onset nonorganic failure to thrive in infants.

Nonorganic failure to thrive (NOFTT) occurs in absence of any gastrointestinal, endocrine, or other chronic diseases. It is usually associated with psychosocial deprivation, although behavior problems may also contribute to its occurrence in absence of maternal pathology. We report seven infants and children between the ages of 13 and 30 months at the time of presentation, who failed to consume adequate calories and suffered from delayed growth. All were born at term after normal pregnancies with birth weights and lengths between the 50th and 95th percentiles except in one. None had any history of perinatal problems. Decreased intake was encountered almost immediately after birth, with lack of interest in consuming adequate calories. The evaluations performed did not reveal any specific etiology for the decreased intake. None had any developmental delay nor were there any psychiatric conditions in mothers. Changes in formulas or psychologic intervention were unsuccessful in modifying feeding habits except in two infants. All were supplemented with enteral supplements (Pediasure-five, Ensure-one, and Osmolite-one). Three did not consume enough orally and needed nasogastric tube infusions with eventual placement of gastrostomy tubes in two, and the third one has continued with nasogastric infusions. A significant increase in caloric intake caused improvement in growth percentiles. Height and weight percentiles improved in all and crept into the normal curve in four and five patients, respectively. Head circumference of two stayed at < 5th percentile despite nutritional rehabilitation. Attempts at weaning off the supplements actually resulted in weight loss in all. Our data suggest that there is a critical need for early, aggressive nutritional intervention in such infants.

Body Height↗