Oito anos do programa de transplante hepático infantil do Hospital de Clínicas de Porto Alegre : acompanhamento da evolução do desenvolvimento físico dos pacientes transplantados

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Gastroesophageal reflux disease: exaggerations, evidence and clinical practice

Objective: there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD) in children. the association between GERD and cow's milk protein allergy (CMPA), overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs) are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children.Data source: a search was conducted in the MEDLINE, Pub Med, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords: gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013.Data synthesis: abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER). Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects.Conclusions: there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. for these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected. (C) 2013 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.Hosp Crianca Santo Antonio, Complexo Hosp Santa Casa, Pediat Gastroenterol Serv, Porto Alegre, RS, BrazilUniv Fed Ciencias Saade Porto Alegre, Dept Pediat, Porto Alegre, RS, BrazilDept Gastroenterol, Soc Brasileira Pediat, Rio de Janeiro, RJ, BrazilHosp Base Distrito Fed, Pediat Unit, Brasilia, DF, BrazilHosp Crianca Brasilia, Brasilia, DF, BrazilCtr Univ Brasilia, Brasilia, DF, BrazilDept Pediat Gastroenterol, Soc Brasileira Pediat, Brasilia, DF, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Pediat, São Paulo, BrazilHosp Israelita Albert Einstein, Clin Especialidades Pediat, São Paulo, BrazilPontificia Univ Catolica Parana, Dept Pediat, Curitiba, PR, BrazilHosp Pequeno Principe, Pediat Gastroenterol Serv, Curitiba, PR, BrazilUniv Fed Bahia, Pediat Gastroenterol & Hepatol Serv, Salvador, BA, BrazilAcad Brasileira Pediat, Rio de Janeiro, RJ, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Pediat, São Paulo, BrazilWeb of Scienc

Infections in pediatric patients submitted to hepatic transplant

OBJETIVO: Identificar infecções bacterianas, virais e fúngicas nos primeiros 20 pacientes pediátricos submetidos a transplante de fígado no HCPA. PACIENTES E MÉTODOS: 21 transplantes foram realizados em 20 crianças e adolescentes, no período de março de 1995 a setembro de 1997, no HCPA. Todos os transplantes foram de doador cadavérico, do mesmo grupo sangüíneo ABO. Nove transplantes foram de fígado inteiro e 11, de fígado reduzido. O diagnóstico de infecção bacteriana foi feito quando havia evidências clínico-laboratoriais e/ou hemocultura e/ou outros culturais positivos. Os vírus pesquisados foram citomegalo e Epstein Barr. Fungos eram pesquisados através de hemoculturas e culturas de secreções, drenos e coleções, cateteres e urina. RESULTADOS: Dos 20 pacientes transplantados, dois morreram nas primeiras 24-48 horas e apenas quatro não apresentaram infecção e/ou culturais positivos, clinicamente significativos. Quatorze pacientes apresentaram infecção bacteriana, sendo que nove pacientes apresentaram mais do que um episódio infeccioso. Os organismos mais freqüentes foram Staphylococus aureus e epidermidis e Xantomonas maltophilia. Cinco receptores positivaram antigenemia para CMV, sendo que apenas um apresentava sorologia negativa no pré-transplante. Infecção fúngica foi diagnosticada em dois pacientes e um terceiro paciente apresentou cultura do dreno biliar positiva. CONCLUSÕES: Dos 20 pacientes transplantados, quatro foram ao óbito por complicações infecciosas. Um controle cuidadoso e medidas profiláticas e terapêuticas adequadas podem diminuir infecções e suas conseqüências após transplante hepático.OBJECTIVE: To identify bacterial, viral, and fungal infections in the first 20 pediatric patients submitted to liver transplant at Hospital de Clínicas de Porto Alegre. PATIENTS AND METHODS: Twenty-one liver transplants were performed in 20 infant and adolescent patients from March 1995 to September 1997, at Hospital de Clínicas de Porto Alegre. All transplanted organs were taken from deceased donors with the same ABO blood type as the organ transplant recipient. Nine patients received a whole liver transplant, and 11 patients received a reduced liver transplant. Bacterial infection was diagnosed by the existence of clinical and laboratory evidence; and/or by hemoculture; and/or by positive cultures. For the diagnosis of viral infections, patients were examined for Epstein Barr virus and for cytomegalovirus. For the diagnosis of fungal infection, hemocultures and secretion cultures were taken, and patients were also submitted to draining and sample collections, such as urine samples using a catheter. RESULTS: Of the 20 organ transplant recipient patients, two died within the first 24- 48 hours, and only four of the patients did not present any infections and/or positive cultures that were clinically significant. Fourteen patients had bacterial infection, and nine patients had more than one case of infection. The most frequently found organisms were Staphylococus aureus and epidermidis, and Xanthomonas maltophilia. Five transplant recipients were positive for cytomegalovirus antigenemia, and only one of these recipients was seronegative before the transplant. Fungal infection was diagnosed in two patients, and a third patient presented a positive culture of the biliary drain. CONCLUSIONS: Of the 20 liver transplant recipients, four died due to infection complications. By exerting a careful control, and establishing appropriate prophylactic and therapeutic measures, infection and its consequences may be reduced

Follow-up of pediatric patients evaluated for liver transplantation

Objetivo: Analisar a evolução de pacientes pediátricos avaliados para Transplante Hepático. Métodos: Foram revisados os prontuários das primeiras 65 crianças e adolescentes portadores de hepatopatias crônicas, com idades de 5 meses a 19 anos (x= 6,8 anos), que foram avaliados, de agosto de 1994 a março de 1996, para realizar transplante de fígado. Os dados colhidos foram referentes às características demográficas dos pacientes, causa da hepatopatia, avaliação psicossocial dos pacientes e de seus responsáveis e avaliação clínico-laboratorial. De acordo com a gravidade da doença, os pacientes foram classificados como ativos (aguardando doação), em avaliação, inativos (hepatopatia compensada) e excluídos por motivos psicossociais, médicos ou por má indicação. Resultados: Oito pacientes (12%) foram transplantados, sendo que somente um foi ao óbito. Sete (11%) morreram enquanto estavam sendo avaliados ou aguardando um órgão. Dez pacientes (15%) foram excluídos da lista de espera: 6 por problemas sociais e 4 por problemas médicos. Nenhum paciente foi afastado por indicação incorreta. Seis pacientes estão em lista ativa, aguardando doador. Dos outros pacientes, 23 (35%) estão em avaliação e 11 (17%) estão como inativos na lista. Conclusões: Onze pacientes (17%) não foram submetidos a transplante devido ao avançado grau da hepatopatia. Enfatizamos a importância da doação de órgãos e o encaminhamento precoce dos pacientes.Objective: To analyze the evolution of pediatric patients chosen for hepatic transplantation. Methods: A review was made of the clinical charts of the first 65 children and adolescents with chronic liver disease, aged 5 months to 19 years (X = 6.8%), chosen for liver transplantation during the period of August 1994 to March 1996. Data refer to the patients’ demographic characteristics, etiology of their liver disease, their psychosocial situation and of their parents, and their clinical and laboratorial evaluation. According to the severity of the disease, patients were classified as active (waiting for a donor), in evaluation, inactive (compensated liver disease), and excluded for psychosocial or medical conditions, or because of bad indication. Results: Eight patients (12%) received transplantation, and one of them died. Seven (11%) died when in evaluation or waiting for a donor. Ten patients (15%) were excluded from the waiting list: 6 for social problems, and 4 for medical problems. No patient was excluded for bad indication. Six patients are in the active list, waiting for donor. The other 23 patients (35%) are in evaluation, and 11 (17%) are classified as inactive in the waiting list. Conclusions: Eleven patients (17%) were not operated on due to the advanced stage of the liver disease. We emphasize the necessity of organ donation, and the early contact of the patients with a reference center