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PubMed1985

[Digestive stenosis after neonatal enterocolitis].

Nineteen clinical cases of intestinal stricture due to neonatal necrotising enterocolitis and a review of available references are presented in this paper. Intestinal strictures are estimated to arise in 20% to 30% on neonatal enterocolitis. However the delay between the acute episode and the occurrence of the stenosis is variable; the depth and the extend, of the necrosis as well as inflammation and superinfection may contribute to the building up of the intestinal stricture. The histological aspects of the lesions are not unique, more over cases of spontaneously regressive stenosis are known. Question thus arising as to the most appropriate timing for surgery and the choice of surgical technics as a function of clinical aspects and of derivation of the disease are discussed in this paper.

Colonic Diseases↗
PubMed1992

[Non-neurologic manifestations in hypoxic-ischemic disease in newborn infants].

The aim of this work is to determine the most important factors related with to the appearance of systemic abnormalities in hypoxic-ischemic illness after neonatal asphyxia. A total of 145 full-terms neonates affected by hypoxic-ischemic encephalopathy (HIE), were studied. Forty-seven infants (32.4%) presented systemic abnormalities (arterial hypotension and acute renal failure, pulmonary abnormalities or necrotizing enterocolitis). A relationship between the presence of HIE and the appearance of extra-neurological abnormalities was found (p = 0.0174). An increase in erythroblasts was related with to the appearance of extra-neurological abnormalities (p = 0.0127).

Abnormalities, Multiple↗
PubMed1985

Hypernatraemic dehydration and necrotizing enterocolitis.

Severe hypernatraemic dehydration developed over the first twelve days of life in a breastfed infant girl. Upon oral rehydration with formula milk, no acute neurological problems arose, but she subsequently developed necrotizing enterocolitis. Intravenous rehydration may be preferred to the oral route in such infants.

Dehydration↗
PubMed1991

Neutropenic enterocolitis following treatment with cytosine arabinoside-containing regimens for hematological malignancies: a potentiating role for amsacrine.

A retrospective clinical study was performed to determine the clinical impact of neutropenic enterocolitis (NE) in adult patients with acute leukemia and non-Hodgkin's lymphoma treated with cytosine arabinoside (Ara-C)-containing regimens. The diagnosis of NE was restricted to conditions with clinical signs of peritonitis, ileus, or intestinal hemorrhage. Forty episodes of NE were noted during 461 Ara-C-containing courses (8.6%) in 36 of 211 patients (17%) over a 6-year period. Clinically, 18 cases of ileus, 16 cases of peritonitis, and 6 cases of intestinal hemorrhage were recognized as the most important presentation of NE. NE started about 2 weeks after the initiation of the chemotherapy and lasted for an average of 1 week. All patients had a profound neutropenia. The incidence of septicemia was higher during courses complicated by NE (p less than 0.001). All cases of NE were treated with conservative measures. The mortality was 22.5% and represented one third of all therapy-related deaths during the pancytopenic period. The incidence of NE was significantly higher in courses consisting of high-dose Ara-C for 6 consecutive days when the drug was combined with amsacrine for 3 consecutive days (p less than 0.0001).

Adult↗
PubMed1986

Acute polycythemia increases the disappearance rate of clottable fibrinogen in the newborn dog.

To explore the pathophysiology of the necrotizing enterocolitis caused by polycythemia in the newborn dog, the effect of acute polycythemia on fibrinogen disappearance rate was studied in 38 puppies (3-14 days). All pups received an exchange transfusion removing 65 ml/kg of blood and transfusing 85 ml/kg of either whole blood (control, resulting hematocrit = 37), or packed red blood cells (polycythemia, resulting hematocrit = 68). Necrotizing enterocolitis was found in 15 of 19 polycythemic and four of 19 control pups (p less than 0.01). 125I fibrinogen and Evan's blue (an albumin marker) were injected 2 h after transfusion and the concentration of clottable labeled fibrinogen and albumin tracer were measured at 1/2 and 2 h after injection. The fraction of the tracer that disappeared over the 1 1/2-h period was calculated. In the polycythemic group 45 +/- 18 SD% of the clottable fibrinogen disappeared versus only 28 +/- 15% in the control group (p less than 0.01). In the polycythemic group 36 +/- 21% of the albumin tracer disappeared versus 31 +/- 12% in the control group (NS). Thus polycythemia in the newborn dog is associated with an increased disappearance rate of clottable fibrinogen not associated with a general increase in protein disappearance rate. Thus an intravascular coagulopathy is evident in the polycythemic animals. Whether this coagulopathy is the cause of the necrotizing enterocolitis or is secondary to the necrotizing enterocolitis seen in this animal model cannot be determined from this experiment.

Animals↗
PubMed1989

Gangrenous acalculous cholecystitis in a premature infant.

Acute acalculous cholecystitis is uncommon, although children are more likely to have this condition than adults. A 1,100-g premature baby girl with a gangrenous acalculous cholecystitis is reported. She presented with clinical and radiographic findings that were initially interpreted as necrotizing enterocolitis. An exploratory laparotomy demonstrated the presence of an acute gangrenous acalculous cholecystitis, and a cholecystectomy was performed. To our knowledge, this one of the smallest patients reported with this entity, and the first whose condition was initially diagnosed as necrotizing enterocolitis. It is important to recognize this entity and consider it in the differential diagnosis of premature infants, because in patients with necrotizing enterocolitis nonoperative management should be attempted initially, and patients with acute gangrenous cholecystitis most likely will require a laparotomy and cholecystectomy.

Acute Disease↗
PubMed1994

Sonography in the infant with acute abdominal symptoms.

The sonogram is a reliable diagnostic tool in the evaluation of acute abdominal disorders in infants and children. Portability, noninvasiveness, and ease of examination make sonography an invaluable diagnostic method. This article considers the principle acute disorders of infancy and childhood that are minimal to sonographic diagnosis. Included are pyloric stenosis, appendicitis, necrotizing enterocolitis, intussusception, as well as unexplained abdominal distention and acutely presenting masses. Although some of these entities have nonspecific sonographic appearances, consideration of age, symptoms, and laboratory results usually permits a specific diagnosis.

Abdomen↗
PubMed1984

[Gastrointestinal complications in children with hemolytic-uremic syndrome].

Eight children out of 106 with haemolytic-uraemic syndrome (HUS) had marked gastrointestinal complications requiring close cooperation between the paediatrician and paediatric surgeon. These children showed signs of ileus and peritonitis. Six children hat these complications in the prodromal stage, whereas the other two children showed them in the anuria stage. The complications were closely connected with multiple erosions of the mucosa and ulcerations of the intestinal wall which resulted in perforation of the intestinal wall in two cases. In two further cases, intestinal vagination was seen which was limited toward the small intestine. All operated children died. The authors are of the opinion that prognosis in HUS with severe gastrointestinal complications is very infaust.

Abdomen, Acute↗
PubMed2006

Ineffective off-label use of recombinant activated factor VII in a case of bone-marrow transplantation-related gastrointestinal bleeding.

BACKGROUND: For patients with a normal coagulation system, who experience serious bleeding, sound evidence for recombinant activated factor VII (rFVIIa) as an effective haemostatic agent is only scarcely available so far from controlled clinical trials. In systematic reviews on the clinical use of rFVIIa, treatment failures were only rarely reported. CASE PRESENTATION: We present a 45-year old, Caucasian male with persistent intestinal bleeding due to enterocolitis associated with cytomegalovirus infection and acute graft-versus-host-disease. He had received allogeneic peripheral blood stem cell transplantation from an unrelated HLA-identical donor because of chronic myelogenous leukaemia diagnosed two years earlier. Bleeding started at day 18 after transplantation with bloody diarrhea, which was treated with multiple transfusions of fresh frozen plasma, platelet, and red blood cell concentrates, and continued relentlessly, despite all efforts, including continued transfusions, high-dose prednisolone, broad antibiotic and antiviral coverage, and tranexamic acid. Recombinant FVIIa was started at boluses of 90-120 mug/kg every 4-8 hours. Despite more than 10 doses, recurrent severe bleeding progressed to refractory shock, multiorgan failure and death. CONCLUSIONS: Little can be concluded from single case reports of clinical improvement, because publication bias in favour of positive effects is likely. Our case suggests that rFVIIa is not a panacea, in particular for severe bleeding after bone-marrow transplantation. As long as rigorous, controlled studies or comprehensive registries are lacking, conventional interventions remain the standard of care in non-haemophilic patients with severe bleeding.

Journal Article↗
PubMed1989

Acute diarrhea in children.

Acute diarrhea is a common problem in children. Understanding the different pathologic processes that cause diarrhea, and the agents that are associated with those processes, can aid the clinician in predicting the etiology of the diarrhea in an individual patient. Small bowel involvement, most commonly caused by Rotavirus, produces a high incidence of vomiting, often before the onset of diarrhea, and large, watery, and relatively infrequent stools. Large bowel involvement, usually due to Campylobacter, Salmonella, or Shigella produces frequent, often bloody stools containing leukocytes. Treatment of diarrhea should be focused on correcting dehydration, principally with oral rehydration solutions containing appropriate concentrations of electrolytes and carbohydrates. Early refeeding, avoiding foods containing lactose, should be considered for most pediatric patients with acute diarrhea. Antimicrobial therapy should be reserved primarily for parasitic infectious, pseudomembranous enterocolitis, and the early stages of a Campylobacter dysentery. The etiology of acute pediatric diarrhea can be predicted in most patients and early, appropriate treatment can be instituted.

Acute Disease↗
PubMed1989

"New" food-borne pathogens of public health significance.

Recent work by epidemiologists and microbiologists has uncovered several hitherto unrecognized food-borne bacterial pathogens of public health significance. One of these, Listeria monocytogenes, has attracted considerable attention because of two major cheese-related outbreaks of listeriosis that were characterized by cases of meningitis, abortion, and perinatal septicemia. Thus far, L. monocytogenes has been responsible for well over 300 reported cases of food-borne listeriosis, including about 100 deaths, and has cost the dairy industry alone more than 66 million dollars as a result of product recalls. The ability of L. monocytogenes to grow at refrigeration temperatures, coupled with appearance of the pathogen in raw and processed meats, as well as poultry, vegetables, and seafood, makes this bacterium a serious threat to susceptible consumers and to the entire food industry. Yersinia enterocolitica, another psychrotrophic food-borne pathogen of recent concern, was linked to several outbreaks of yersiniosis associated with consumption of both raw and pasteurized milk, as well as contaminated water. Food-borne infections involving Y. enterocolitica typically result in enterocolitis, which may be mistaken for acute appendicitis. Unfortunately, inadvertent removal of healthy appendixes from victims of food-borne yersiniosis is all too common. Although known for many years, Campylobacter jejuni has only recently been recognized as a food-borne pathogen and a leading cause of gastroenteritis in the United States. Notable outbreaks of campylobacteriosis linked to consumption of raw milk, cake icing, eggs, poultry, and beef have underscored the need for thorough cooking and proper handling of raw products.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

[Neonatal exchange transfusion with irradiated whole blood. Preliminary results].

Some clinical manifestations following exchange transfusion (ET) could result from graft versus host disease secondary to the introduction of viable foreign T lymphocytes: skin rash, fever, acute and sometimes bloody diarrhea or enterocolitis. Between February 1985 and January 1989 the blood used for 31 ET was irradiated at 40 grays. We compared the manifestations occurring during the days following ET to those occurring after 44 previous ET with non irradiated blood during the period January 1981 to January 1985. From 1981 to 1985, 13 of 44 infants developed problems within 3 days following ET: an erythematous macular skin rash in 4; gastrointestinal manifestations (diarrhea, vomiting and rectal bleeding, necrotizing enterocolitis) in 7; both skin lesions and a gastrointestinal problem in 2. Since 1985, 27 infants had no problems whereas only 4 developed gastrointestinal or cutaneous manifestations: NEC in a preterm infant, abdominal distension with rectal bleeding, fever and petechial rash in 2 infected infants. These data show a dramatic decrease of complications since the irradiation of blood products has been started: 30% with non irradiated, 13% with irradiated blood.

Exchange Transfusion, Whole Blood↗