RESUMO
OBJECTIVE: To determine whether children with homozygous sickle cell (SS) disease and splenectomy are at greater risk of death, overwhelming septicemia, or other complications. METHODS: A total of 130 patients with SS treated by splenectomy (46 recurrent acute splenic sequestration, 84 chronic hypersplenism) over a 22.5-year period at the Sickle Cell Clinic of the University Hospital of the West Indies, Kingston, Jamaica, were compared with a control group matched for sex, age, and duration of follow-up in a retrospective review. Deaths and bacteremias were examined over the whole study period. Painful crises, acute chest syndromes, and febrile episodes were compared in the 90 patients completing 5 years of postsplenectomy follow-up. FINDINGS: Mortality and bacteremic episodes did not differ between the splenectomy and control groups. Painful crises were more common in the splenectomy group than in the control group (P = .01) but did not differ between splenectomy indications. Acute chest syndrome was more common in the splenectomy group than in the control group (P < .01) and was more common in the acute splenic sequestration group than in the hypersplenism group (P = .01). Febrile events did not differ between the groups or between the indications for splenectomy. CONCLUSION: Splenectomy does not increase the risk of death or bacteremic illness in patients with SS disease and, if otherwise indicated, should not be deferred for these reasons (Au)
Assuntos
Adulto , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Lactente , Estudo Comparativo , Anemia Falciforme/complicações , Homozigoto , Esplenectomia/normas , Antibioticoprofilaxia , Bacteriemia/epidemiologia , Bacteriemia/prevenção & controle , Estudos de Casos e Controles , Causas de Morte , Distribuição de Qui-Quadrado , Seguimentos , Jamaica/epidemiologia , Modelos Logísticos , Penicilinas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Anemia Falciforme/mortalidade , Anemia Falciforme/cirurgiaRESUMO
The dumping syndrome in childhood is an uncommon complication of gastro-oesophageal surgery, principally Nissen fundoplication. A Jamaican child developed the syndrome after fundoplication and pyloroplasty to relieve gastro-oesophageal reflux complicating the repair of a congenital tracheo-oesophageal fistula. He developed marasmus and failed to gain weight on the standard remedial milk-based high energy diet. An oral glucose tolerance test confirmed the diagnosis of dumping syndrome. A low sugar low milk diet based on adult type meals with continous nibbling of fried dumplings relieved his diarrhoea and hypoglycaemia and he gained weight. This is a cheaper and more practical dietary therapy than the regimens described previously(AU)
Assuntos
Humanos , Lactente , Síndrome de Esvaziamento Rápido/etiologia , Síndrome de Esvaziamento Rápido/dietoterapia , Síndrome de Esvaziamento Rápido/epidemiologia , Fundoplicatura/efeitos adversos , Jamaica/epidemiologia , Nefropatias/cirurgia , Antro Pilórico/cirurgiaRESUMO
Data were collected prospectively on 57 Jamaican children presenting with 62 episodes of acute intussusception over a two year period, for whom operative and hydrostatic methods of reduction were employed. 31 (54 percent) of 57 episodes were reduced successfully using barium (42), saline (11) and air (4) hydrostatically. Among the 31 other episodes, 15 had ileo-colic intussusception, seven caeco-colic, six ileo-ileo-colic and one ileo-ileal. Two patients had spontaneous reduction discovered at surgery. There were two episodes of barium hydrostatic perforation of the colon leading to death in one patient. Hydrostatic reduction is recommended as the first therapeutic option for acute intussusception because it spares the patient a major operative procedure when successful(AU)
Assuntos
Feminino , Humanos , Lactente , Masculino , Intussuscepção/terapia , Irrigação Terapêutica , Doença Aguda , Sulfato de Bário/uso terapêutico , Enema , Pressão Hidrostática , Intussuscepção/etiologia , Estudos Prospectivos , Cloreto de Sódio/uso terapêuticoRESUMO
Portal hypertension and bleeding from oesophageal varices in children remain a difficult medical problem. The clinical course and management of children with portal hypertension seen over a 14-year period was reviewed. There were 5 females and 2 males with a mean age of 3.6 years at presentation. Five patients presented with severe upper gastrointestinal bleeding and two with severe hypersplenism. All patients had extra-hepatic portal hypertension. Five patients were treated with endoscopic sclerotherapy, including one who had bleeding five years post-splenectomy. A mean of 9 sclerotherapy sessions was performed in each patient. Complete obliteration of varices was not achived in any patient and a single rebleeding episode occurred in four. Three children underwent operative management consisting of splenectomy in two and splenectomy and central spleno-renal shunt in one. There was no mortality in either group after a mean follow-up of 4.3 years. Sclerotherapy may not be totally successful in long-term management of childhood portal hypertension. Surgical therapy or a combination of sclerotherapy and surgery may be the best approach
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Varizes Esofágicas e Gástricas/terapia , Escleroterapia , Hipertensão Portal/complicações , Hipertensão Portal/terapia , Esplenomegalia , Estudos RetrospectivosRESUMO
Portal hypertension and bleeding from oesophageal varices in children remain a difficult medical problem. The clinical course and management of children with portal hypertension seen over a 14-year period was reviewed. There were 5 females and 2 males with a mean age of 3.6 years at presentation. Five patients presented with severe upper gastrointestinal bleeding and two with severe hypersplenism. All patients had extra-hepatic portal hypertension. Five patients were treated with endoscopic sclerotherapy, including one who had bleeding five years post-splenectomy. A mean of 9 sclerotherapy sessions was performed in each patient. Complete obliteration of varices was not achived in any patient and a single rebleeding episode occurred in four. Three children underwent operative management consisting of splenectomy in two and splenectomy and central spleno-renal shunt in one. There was no mortality in either group after a mean follow-up of 4.3 years. Sclerotherapy may not be totally successful in long-term management of childhood portal hypertension. Surgical therapy or a combination of sclerotherapy and surgery may be the best approach (AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Varizes Esofágicas e Gástricas/terapia , Hipertensão Portal/complicações , Hipertensão Portal/terapia , Escleroterapia , Estudos Retrospectivos , EsplenomegaliaRESUMO
Although trichuriasis is the most prevalent known infection in the CARICOM countries, only a small proportion of infected children acquire intense infection, i.e., Trichuris Dysentry Syndrome (TDS). Hypotheses to be investigated are that there is a specific T-Cell anergy to the parasite in such hosts or that they have general predisposition to the "TH2" T-helper-cell response, which would be in keeping with the TDS local anaphylactic response we have shown by various techniques in our other reports. We investigated 3 groups of children: controls from a surgical private practice unlikely to have ever been significantly infected TDS cases. We used the ELISPOT technique with primary and secondary monoclonal antibodies to show cytokine production by cells separated from peripheral blood or colonic mucosal biopsies, expressing the final result in numbers of positive cells per 100,000 CD3+ cells (T-cells). Interferon-gamma detection was taken as indicative of the TH1 phenotype and Interleukin 4 (IL4) as indicative of TH2. Spontaneous production in short-term culture was compared with that after stimulation ionophore, staphylococcal enterotoxin B (superantigen) or T. trichiura excretory-secretory (ES) antigen. There was great variability in proportions of cytokine positive cells after culture, both spontaneously and after stimulation. There was also variability in the rank of potency of a given stimulant to "the T-cells of different children. ES antigen provoked the greatest IL4 response for one active TDS case, refuting the anergy hypothesis. The active cases had two highest productions (spontaneous) of interferon-gamma and (stimulated) of IL4. No significant difference in Th1/Th2 phenotypic profile emerged between the control and ex-TDS groups. We conclude that it is not innate character in T-helper-cell response to mitogen or antigen that accounts for predisposition to intense trichuriasis (AU)
Assuntos
Humanos , Criança , Tricuríase/imunologia , Citocinas , Linfócitos T Auxiliares-Indutores , Anticorpos Monoclonais , Interferon gamaRESUMO
Data were collected prospectively on 57 patients presenting with 62 episodes of acute intussusception between September, 1992 and August, 1994. Both operative and hydrostatic methods (barium, air, saline) of reduction were used. Fifty-seven episodes were subject to hydrostatic reduction, 31 of them being reduced successfully, a success rate of 54 percent. Barium, saline and air were employed in 42, 11 and 4 cases, respectively. There were 2 cases of barium colonic perforation leading to mortality in 1. Among 31 cases not having successful hydrostatic reduction, 15 had ileocolic intussusception, 7 had caecocolic, 6 had ileo-ileo-colic, 1 had ileoileal and 2 were found spontaneously reduced at surgery. We believe that hydrostatic methods should be a first treatment option for acute intussusception in third world institutions. Our study shows that satisfactory rates of reduction can be achieved outside of the first world with the main advantages relating to cost and patient morbidity (AU)
Assuntos
Humanos , Intussuscepção/terapia , Jamaica , Bário/administração & dosagem , Estudos RetrospectivosRESUMO
Chronic hypersplenism in homozygous sickle cell (SS) disease markedly increases haemolysis and the resulting erythropoietic expansion is likely to have a high metabolic cost. Splenectomy for hypersplenism in SS disease is followed by highly significant changes in haematological indices and an increase in height, but not weight, velocity. This pattern is similar to that observed in the trichuris dysentery syndrome after treatment, and differs from the increase in both height and weight velocity that follow nutritional supplementation of severely malnourished children. It is postulated that accelerated linear growth after the reduction in erythropoietic stress may implicate a specific nutrient deficiency in hypersplenic children with SS (AU)
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Crescimento , Hiperesplenismo/cirurgia , Traço Falciforme/complicações , Peso Corporal , Estatura , Índices de Eritrócitos , Testes Hematológicos , Hiperesplenismo/sangue , Hiperesplenismo/fisiopatologia , Traço Falciforme/sangue , Traço Falciforme/fisiopatologia , Traço Falciforme/cirurgia , EsplenectomiaRESUMO
Of the twenty-nine children with solid tumours treated at the University Hospital of the West Indies (UHWI) between January, 1972 and December, 1991, there were twenty-eight cases of nephroblastoma and one of mesoblastic nephroma. Peak incidence was between the ages of two and four years. Twenty-five children had radical nephrectomy while one had bilateral partial nephrectomy. In thirteen cases, pre-operative chemotherapy and radiotherapy was used. Post-operative chemotherapy and radiotherapy were used in 24 and 13 cases, respectively. Stage of the tumour was the most decisive factor influencing the outcome. Whereas there was 100 per cent cure rate in Stages I and II, Stage III had only a 55.5 per cent survival rate and non of the Stage IV survived. Bilateral (Stage V) tumours are curable if individual tumours are localised, as in one of the two cases. The benign mesoblastic nephroma, in a one-month-old infant, was cured by nephrectomy alone. While the present therapy of radical nephrectomy along with combination chemotherapy is satisfactory for early stages, more aggressive adjuvant therapy is needed for improving the results in Stages III and IV
Assuntos
Lactente , Pré-Escolar , Criança , Humanos , Masculino , Feminino , Tumor de Wilms , Neoplasias Renais , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Nefroma Mesoblástico , Tumor de Wilms/diagnóstico , Tumor de Wilms/mortalidade , Tumor de Wilms/terapia , Nefropatias/diagnóstico , Nefropatias/mortalidade , Nefropatias/terapia , Estadiamento de NeoplasiasRESUMO
A retrospective analysis of 26 children with neuroblastic tumours treated at the University Hospital of the West Indies (UHWI) between 1970 and 1991 was undertaken to evaluate factors affecting prognosis. The peak incidence was between 48 months and 60 months of age, and 75//of the deaths occurred in children older than 3 years. The abdomen was the most common site of the tumours 79//of which were from the adrenal gland and carried a dismal outcome. Other sites were thoracic, pelvic and cervical. Extra-adrenal tumours have a good outcome even when the histology is unfavourable; 92//of the tumours were in Stages III or IV at the time of initial presentation. Stage IV disease accounted for all but one of the deaths. Of the 8 children with favourable histology (ganglioneuroma or well-differentiated ganglioneuroblastoma), only one (12.5//) died, whereas of the remaining 18 cases with unfavourable histology (neuroblastoma and undifferentiated ganglioneuroblastoma), eleven (61//) died. When managed by surgery alone or with adjuvant chemo- and/or radio-therapy, only 36.4//succumbed while all 4 children with chemotherapy only died. Ten children are alive without disease for more than three years post-therapy. A scoring system was designed which takes into account the factors influencing the outcome in neuroblastic tumours, namely, age, location, stage and histological types of the tumours and therapy. All the children with a score of 21 or less survived, whereas all those with scores of 22 or above succumbed. This underlines the multifactorial influences on the final outcome of neuroblastic tumours