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The article describes the case of a 16 year old Native American female without significant past medical history presented with a 3-week history of vomiting and diarrhea. She also reported diffuse colicky abdominal pain, anorexia and weight loss. She was transferred to the pediatric intensive care unit after developing a worsening dehydration. An immunocompetent child who developed significant Cytomegalovirus Entiritis requiring antiviral medication treatment was reported.

Presents a case of a child with Crohn's disease complicated by bullous pemphigoid. Findings of laboratory examinations on the patient; Clinical presentation of the child; Treatment administered to the patient; Information on bullous pemphigoid.

Studies childhood Ruvalcaba-Myhre-Smith syndrome, a member of the familial polyposis syndrome group characterized by macrocephaly, pigmented macules on the penis and intestinal polyposis. Clinical manifestations; Results of diagnostic procedures; Inheritance pattern.

Presents a medical case of a young boy diagnosed with perianal streptococcal dermatitis who developed desquamation of fingers. Case presentation; Diagnosis of the disease; Treatment prescribed.

The article outlines the strategy taken by the University of Mississippi Medical Center (UMMC) during the first four years of its quality improvement program. Topics mentioned include the two building blocks of the program, the three pillars of the program that the Center for Transforming Healthcare modeled for health care, and three approaches taken by UMMC to improve leadership engagement warrant discussion.

The article presents a case study of an infant with a history of diffuse petechial rash, intermittent fever, anemia and thrombocytopenia. The patient has also exhibited gastroesophageal reflux, nonbloody vomiting and diarrhea. Results of the various tests conducted on the patient led to the diagnosis of protein-losing enteropathy caused by intestinal and colonic involvement with Langerhans cell histiocytosis (LCH). The patient has underwent chemotherapy involving vinblastine and prednisone.

The article describes the case of a 22-month-old female child diagnosed with Ménétrier's disease (MD). Some of the symptoms reported include progressive lethargy, vomiting and edema. Physical and laboratory examinations of the patient revealed low total protein and abnormalities in the stomach. The necessity of performing gastric biopsies to understand development of MD is also explained.

Background: Esophageal foreign body impaction (EFBI) is a common problem requiring urgent endoscopy. EFBI may be the first sign of underlying esophageal pathology, yet mucosal biopsies are rarely performed.Methods: We report a retrospective analysis of 572 children requiring removal of an EFBI over a 12-year period by pediatric otolaryngologists (ENT), surgeons (PS), and gastroenterologists (PGI). The method of removal [direct laryngoscopy (DL), rigid endoscopy (RE), flexible endoscopy (FE)], type of foreign body (inanimate or food), whether mucosal biopsies were performed, and histologic findings of biopsy samples were recorded for each patient.Results: Foreign body removal was most commonly performed by PGI (298 [52 %]); the remaining were equally distributed between ENT (136 [24 %]) and PS (138 [24 %]). The method of foreign body removal used by ENT was RE (89 %), DL (8 %), and FE (3 %). Pediatric surgery preferred FE (62 %), followed by RE (27 %) and DL (11 %). Pediatric gastroenterology used FE exclusively. Esophageal biopsies were never performed by ENT or PS; PGI performed esophageal biopsies more commonly in children with meat bolus impactions (50 %) than in children with inanimate foreign bodies (12 %). Mucosal pathology was more common in children with meat bolus impaction (100 %) than in children with inanimate foreign bodies (45 %).Conclusions: Esophageal mucosal biopsy should be considered for all children with EFBI not attributed to stricture, particularly those with meat bolus impaction. [ABSTRACT FROM AUTHOR]

Background: Esophageal foreign body impaction (EFBI) is a common problem requiring urgent endoscopy. EFBI may be the first sign of underlying esophageal pathology, yet mucosal biopsies are rarely performed. Methods: We report a retrospective analysis of 572 children requiring removal of an EFBI over a 12-year period by pediatric otolaryngologists (ENT), surgeons (PS), and gastroenterologists (PGI). The method of removal [direct laryngoscopy (DL), rigid endoscopy (RE), flexible endoscopy (FE)], type of foreign body (inanimate or food), whether mucosal biopsies were performed, and histologic findings of biopsy samples were recorded for each patient. Results: Foreign body removal was most commonly performed by PGI (298 [52 %]); the remaining were equally distributed between ENT (136 [24 %]) and PS (138 [24 %]). The method of foreign body removal used by ENT was RE (89 %), DL (8 %), and FE (3 %). Pediatric surgery preferred FE (62 %), followed by RE (27 %) and DL (11 %). Pediatric gastroenterology used FE exclusively. Esophageal biopsies were never performed by ENT or PS; PGI performed esophageal biopsies more commonly in children with meat bolus impactions (50 %) than in children with inanimate foreign bodies (12 %). Mucosal pathology was more common in children with meat bolus impaction (100 %) than in children with inanimate foreign bodies (45 %). Conclusions: Esophageal mucosal biopsy should be considered for all children with EFBI not attributed to stricture, particularly those with meat bolus impaction. [ABSTRACT FROM AUTHOR]

In children, most colonic polyps are juvenile polyps with negligible risk for malignant transformation. The exception is juvenile polyposis syndrome (JPS) where there is a risk for developing colon cancer. The authors studied differences in clinical features and colonoscopic findings in children with solitary juvenile polyps (SJP), multiple juvenile polyps (MJP), and JPS. Methods. Children were identified as SJP (1 polyp), MJP (2-4 polyps), or JPS (>5 polyps). Demographic data, laboratory values, family history, and colonoscopic findings were recorded. Results. Children having polypectomy had juvenile polyps (93%), adenomatous polyps (5%), and Peutz–Jegher syndrome (3%). Juvenile polyps were classified as SJP (67%), MJP (16%), and JPS (17%). Children with SJP were younger, were more likely to have polyps limited to the rectosigmoid colon, and had larger polyps than children with MJP and JPS. Anemia was more common in JPS than MJP and SJP. Conclusion. Clinical and endoscopic findings differ between SJP, MJP, and JPS. [ABSTRACT FROM PUBLISHER]

Background: Gastrostomy tubes (GT) are often required to safely provide nutrition in children with feeding disorders and aspiration risk. The need for a GT brings with it known risks, complications, and benefits, but caregivers may have unspoken concerns and expectations. The present study was done to assess caregiver concerns, expectations, and satisfaction with GT placement in children. Methods: A two-part retrospective and prospective study was conducted to assess caregiver concerns and expectations related to GT placement, to determine which concerns and expectations came to fruition, and to rate overall satisfaction with the GT. Questionnaires were used to collect data before and after GT placement. A visual analog scale (VAS) score was used to determine degree of concern and satisfaction. Results: Sixty-four children (19 retrospective, 45 prospective) completed the study. Concern score by VAS was evenly distributed with a mean value of 47.4 ± 31.8. Concerns were realized in 25%; expectations were met in 93%. Feeding time decreased following GT placement. Satisfaction was reported as satisfied (23.6%), pleased (16.4%), or very pleased (60.0%). Conclusions: Despite pre-placement concerns, most caregivers reported being pleased with the GT following placement. Concerns that occurred were of minor medical significance. Most expectations were met, in particular improved nutrition. The present study provides insight into caregiver concerns and expectations, and which are likely to occur. This information can be useful when counseling caregivers of children requiring GT. [ABSTRACT FROM AUTHOR]

Describes the case of a 12-year-old girl who presented with a history of intermittent abdominal pain and who was diagnosed with Peutz-Jeghers syndrome. Dark-brown pigmented lesions on the lower lip; Confirmation of all the polyps as Peutz-Jeghers polyps through histology; Definition of Peutz-Jeghers syndrome as an autosomal dominant inherited condition characterized by mucocutaneous pigmentation and gastrointestinal polyps; Classification of gastrointestinal polyps as hamartomas.

Children with gastroesophageal reflux disease (GERD) may benefit from gastric acid suppression with proton pump inhibitors such as pantoprazole. Effective treatment with pantoprazole requires correct dosing and understanding of the drug’s kinetic profile in children. The aim of these studies was to characterize the pharmacokinetic (PK) profile of single and multiple doses of pantoprazole delayed-release tablets in pediatric patients with GERD aged 6 to 11 years (study 1) and 12 to 16 years (study 2). Patients were randomly assigned to receive pantoprazole 20 or 40 mg once daily. Plasma pantoprazole concentrations were obtained at intervals through 12 hours after the single dose and at 2 and 4 hours after multiple doses for PK evaluation. PK parameters were derived by standard noncompartmental methods and examined as a function of both drug dose and patient age. Safety was also monitored. Pantoprazole PK was dose independent (when dose normalized) and similar to PK reported from adult studies. There was no evidence of accumulation with multiple dosing or reports of serious drug-associated adverse events. In children aged 6 to 16 years with GERD, currently available pantoprazole delayed-release tablets can be used to provide systemic exposure similar to that in adults. [ABSTRACT FROM PUBLISHER]

Background Granulomatous gastritis (GG) is an uncommon pathological finding that may accompany systemic disease, infections, foreign body reaction, malignancy or vasculitis, but may also be an isolated finding. Clinical and pathological features of GG have been systematically evaluated in adults but not children. Objectives To compare clinical and pathological features of GG in adults and children, and also determine the prevalence of GG in children from a single centre. Methods A retrospective analysis of 23 children and 23 adults with GG was conducted. Demographic and clinical information was recorded for each patient. Gastric biopsy specimens were evaluated for the presence of gastritis, infectious organisms, and number and location of the granulomas. Results Children were a mean±SD age of 12.5±3.0 years, had a male predominance, and were most often Caucasian. Adults were a mean±SD age of 49.2±13.2 years, had a female predominance, and were most often African-American. Primary diagnoses were Crohn's disease in children, and sarcoidosis and isolated GG in adults. In both groups, granulomas were most often located in the antrum, with no difference in the number of granulomas per biopsy between children and adults. All biopsy specimens were negative for acid-fast bacilli and fungal organisms; Helicobacter pylori infection was uncommon. Overall prevalence of GG in children in this study was 1.7% for all diagnostic upper endoscopies. Conclusion Differences in aetiology of GG between children and adults reflect age-specific disease states. Gender differences can be partially explained by gender differences intrinsic to the underlying aetiology. Irrespective of the underlying aetiology, the number and location of granulomas are similar in children and adults. [ABSTRACT FROM AUTHOR]

The article discusses the risk of bezoars to the infants. The author claims that bezoars arise from ingestion of indigestible material, in which common types of bezoars are phytobezoars, trichobezoars, and pharmacobezoars. It says that bezoars are defined as accumulation of foreign ingested material in the form of masses or concretions. It is consist of vegetable matter, hair, and ingested medications. Further, individuals with impaired gastric emptying, anatomic abnormalities of the gastrointestinal tract or previous abdominal surgery are at increased risk for developing bezoars. Moreover, bezoars have symptoms including abdominal pain, nausea, vomiting, early satiety, anorexia, and weight loss.