Diffuse duodenal nodular lymphoid hyperplasia: a large cohort of patients etiologically related to Helicobacter pylori infection

Abstract Background Nodular lymphoid hyperplasia of gastrointestinal tract is a rare disorder, often associated with immunodeficiency syndromes. There are no published reports of its association with Helicobacter pylori infection. Methods From March 2005 till February 2010, we prospectively followed all patients with diffuse duodenal nodular lymphoid hyperplasia (DDNLH). Patients underwent esophagogastroduodenoscopy with targeted biopsies, colonoscopy, and small bowel video capsule endoscopy. Duodenal nodular lesions were graded from 0 to 4 based on their size and density. Patients were screened for celiac sprue (IgA endomysial antibody), immunoglobulin abnormalities (immunoglobulin levels & serum protein electrophoresis), small intestine bacterial overgrowth (lactulose hydrogen breath test), and Helicobacter pylori infection (rapid urease test, and histological examination of gastric biopsies). Patients infected with Helicobacter pylori received sequential antibiotic therapy and eradication of infection was evaluated by 14C urea breath test. Follow up duodenoscopies with biopsies were performed to ascertain resolution of nodular lesions. Results Forty patients (Males 23, females 17; mean age ± 1SD 35.6 ± 14.6 years) with DDNLH were studied. Patients presented with epigastric pain, vomiting, and weight loss. Esophagogastroduodenoscopy showed diffuse nodular lesions (size varying from 2 to 5 mm or more) of varying grades (mean score ± 1SD 2.70 ± 0.84) involving postbulbar duodenum. Video capsule endoscopies revealed nodular disease exclusively limited to duodenum. None of the patients had immunoglobulin deficiency or small intestine bacterial overgrowth or positive IgA endomysial antibodies. All patients were infected with Helicobacter pylori infection. Sequential antibiotic therapy eradicated Helicobacter pylori infection in 26 patients. Follow up duodenoscopies in these patients showed significant reduction of duodenal nodular lesions score (2.69 ± 0.79 to 1.50 ± 1.10; p Helicobacter pylori infection showed no significant reduction of nodular lesions score (2.71 ± 0.96 to 2.64 ± 1.15; p = 0.58). Nodules partially regressed in score in 2 patients, showed no interval change in 10 patients and progressed in 2 patients. Conclusions We report on a large cohort of patients with DDNLH, etiologically related to Helicobacter pylori infection.</p

PEDIATRICS INTERNATIONAL

Background: The pathogenic role of TT virus (TTV) is not clear in patients with chronic hepatitis B. The aims of the present study were to determine the frequency of TTV positivity in serum and saliva samples and the possible role of TTV in children with chronic hepatitis B. Methods: Sera and saliva from 29 healthy children and 25 children with chronic hepatitis B were tested for TTV-DNA by means of real-time polymerase chain reaction (PCR). Results: Fifty-two percent (13/25) of the serum samples and 32% (8/25) of the saliva samples were positive for TTV-DNA in children with chronic hepatitis B. In healthy non-transfused children, TTV-DNA was detected in 58% (17/29) of the serum samples and 41% (12/29) of the saliva samples. Six (46%) of 13 children with chronic hepatitis and 10 (59%) of 17 healthy children had TTV-DNA positivity both in serum and saliva samples. Two serum samples were negative for TTV-DNA while the saliva samples were positive for TTV-DNA in chronic hepatitis B and control groups. Mean age, sex, serum alanine aminotransferase levels, hepatitis B virus (HBV)-DNA values were similar in TTV-positive and -negative children with chronic hepatitis B. However, total histologic activity index (HAI), periportal necrosis and portal inflammation scores were significantly higher in children with HBV-DNA and TTV-DNA viremia (P = 0.013, P = 0.008, P = 0.015, respectively). Conclusions: Because total HAI, periportal necrosis and portal inflammation scores were higher in children with TTV coinfection, TTV infection may contribute to the progression of liver damage in children with chronic hepatitis B

TURKISH JOURNAL OF PEDIATRICS

There are controversial results about the role of dysfunctional bowel emptying in disorders of the urinary tract like urinary tract infection (UTI), vesicoureteral reflux (VUR) and enuresis. Constipation may cause UTI, enuresis and VUR due to the uninhibited bladder contraction. The aim of this study was to investigate the frequency of nocturnal enuresis, UTI and instability symptoms in chronic functional constipation (CFC). This study included 38 children with CFC and 31 children as the control group. Detailed past and present history of UTIs or symptoms pointing to this diagnosis, enuresis, encopresis, urgency and urge incontinence was obtained from both groups as well as the family history of UTI. Urinalysis, urine culture and stool parasite analysis as well as abdominal ultrasonography were performed on both groups. Age range of the children with CFC was 6-192 months (mean +/- standard deviation (SD) 63.5 +/- 51 months); that of the control group was 4-180 months (mean +/- SD 82 +/- 46.2 months). Frequency of UTI and urgency was significantly higher in the CFC group. However, frequencies of urge incontinence, nocturnal enuresis, and genitourinary abnormalities were not different between the two groups. In conclusion, risk of UTI and urgency is increased in CFC, but that of other voiding dysfunctions like urge incontinence do not change significantly. Therefore, we suggest that UTI and urgency should be questioned in children with CFC and vice versa

TURK PEDIATRI ARSIVI-TURKISH ARCHIVES OF PEDIATRICS

Stool is not just a simple waste material. Some stool tests can be easily used in primary care in the differential diagnosis of disorders such as gastrointestinal infections, malabsorption syndromes, and inflammatory bowel diseases. Stool tests can prevent unnecessary laboratory investigations. Stool analyses include microscopic examination, chemical, immunologic, and microbiologic tests. Stool samples can be examined for leukocytes, occult blood, fat, sugars (reducing substances), pH, pancreatic enzymes, alpha-1 antitrypsin, calprotectin, and infectious causes (bacteria, viruses, and parasites). Stool should also be macroscopically checked in terms of color, consistency, quantity, shape, odor, and mucus

PEDIATRICS INTERNATIONAL

Background: The aim of the present study was to evaluate the efficacy of treatment with recombinant interferon (IFN)-alpha 2b in 12 children with chronic hepatitis B who had previously undergone therapy for cancer. Methods: Nine children had acute leukemias and the other three children had solid tumors. The mean (+/-SD) age of the children was 8.4 +/- 3.8 years (range 4-16 years). All cases were hepatitis B virus (HBV)-DNA positive and 11 were hepatitis B e antigen (HBeAg) positive. One was anti-HBe positive (mutant strain). Four cases were anti-delta IgG positive. Liver biopsy revealed chronic hepatitis B in 11 patients and cirrhosis in one patient. Interferon-alpha 2b was given at a dose of 5 MU/m(2) three times a week, subcutaneously, for 12 months. Results: Elimination of serum HBV-DNA was obtained in three cases, but a further three patients demonstrated a marked decrease in HBV-DNA levels after therapy. Three of 11 patients seroconverted from HBeAg to anti-HBe. Alanine aminotransferase (ALT) levels returned to normal in three of nine cases in whom the ALT levels were high before treatment. At the end of therapy, the mean histologic activity index score was significantly diminished (P = 0.0039). Conclusions: In conclusion, a 12 month course of IFN-alpha 2b induces some beneficial effects on virologic, biochemical and histologic indices in children with chronic hepatitis B who have previously undergone therapy for cancer

SUBSTRATE REMOVAL IN LONG SEWER LINES

Wastewaters generated from large dwelling areas are collected and disposed of by means of long sewer trunk lines. The wastewater treatment potential of sewers is not a novel phenomenon, however, it has not been thoroughly investigated in the past. In this study, possible treatment efficiencies are estimated in the presence of sufficient oxygen. Suspended and attached growth kinetics are studied to explore the significance of aeration in sewer trunks. Although there are several existing models describing consumption mechanisms of soluble substrates and reaction rates, a new method is investigated in this paper for shortening the parameters used in biological rate equations. Soluble substrate consumptions of suspended growth microorganisms are taken into consideration by means of an experimental approach and they are estimated by using respiration rates. Relationships between respiration rate, substrate utilization rate and biodegradable organic matter concentrations are observed during the experimental program. An empirical relationship which provides the utilization rate in correspondence with diminishing substrate concentrations along a sewer line is developed based upon the experimental results. Expected treatment efficiencies are determined considering utilization rates of attached and suspended growth microorganisms

Blood levels of leukotrienes (LTC 4, D 4, E 4, B 4) and synthesis of leukotriene B 4 by peripheral leukocytes in children with acute a and B hepatitis

PubMed ID: 10770113Leukotrienes (LTs) are cell-membrane derived lipid inflammatory mediators, synthesized and eliminated by the liver. LTs have effects on liver cells in some pathological conditions. In this study, we measured plasma endogenous and liberated leukotriene (LT) concentration in peripheral blood leukocytes stimulated in vitro by the calcium ionophore (CaA23187) and platelet-activating factor (PAF). Production of LTs was measured in type A (n=37) and type B (n=10) acute hepatitis patients and control subjects (n=10). LTs levels were measured by high performance liquid chromatography (HPLC) and radioimmunoassay (RIA). The concentration of LTB 4 measured in plasma and stimulated peripheral blood leukocyte supernatants of children with hepatitis A infection was found to be statistically elevated and in positive correlation with serum alanine aminotransferase (ALT) levels. In plasma samples of hepatitis B patients, LTC 4 and LTE 4 were measured in significantly elevated concentrations. These results suggest that LTB 4 may be a critical mediator of hepatitis A virus-induced hepatocellular injury

Retinol and ?-tocopherol concentrations in breast milk of Turkish lactating mothers under different socio-economic status

PubMed ID: 17852471Retinol and ?-tocopherol levels in breast milk of Turkish mothers under different socio-economic status were investigated. Mature milk samples were collected from 92 lactating mothers living in Izmir and in Manisa, cities of Turkey, who were at 60-90 days of the lactating period. Socio-economic, anthropometric, and dietary data were collected by means of a questionnaire. The body mass index was used to determine the nutritional status. The retinol and ?-tocopherol contents of breast milk were determined by high-performance liquid chromatography; the concentration of ?-tocopherol was 9.84 µg/ml whereas retinol levels were 81.5 µg/100 ml. The questionnaire survey was used to determine the level of these vitamins in the daily ration of the women. No significant differences were found in terms of milk retinol and ?-tocopherol levels for the variables income, educational level and mothers' body mass index.Assumption College Celal Bayar ÜniversitesiThe authors thank the Celal Bayar University Research Fund for their financial support and thank the AC¸ SAP (Mother and Infant Health Planning) Centers in İzmir and Manisa for kind help with the supply of human milk samples. -

Efficacy of interferon-alpha 2b treatment in children with chronic hepatitis B who have previously undergone therapy for cancer

WOS: 000166527400009PubMed ID: 11192521Background: The aim of the present study was to evaluate the efficacy of treatment with recombinant interferon (IFN)-alpha 2b in 12 children with chronic hepatitis B who had previously undergone therapy for cancer. Methods: Nine children had acute leukemias and the other three children had solid tumors. The mean (+/-SD) age of the children was 8.4 +/- 3.8 years (range 4-16 years). All cases were hepatitis B virus (HBV)-DNA positive and 11 were hepatitis B e antigen (HBeAg) positive. One was anti-HBe positive (mutant strain). Four cases were anti-delta IgG positive. Liver biopsy revealed chronic hepatitis B in 11 patients and cirrhosis in one patient. Interferon-alpha 2b was given at a dose of 5 MU/m(2) three times a week, subcutaneously, for 12 months. Results: Elimination of serum HBV-DNA was obtained in three cases, but a further three patients demonstrated a marked decrease in HBV-DNA levels after therapy. Three of 11 patients seroconverted from HBeAg to anti-HBe. Alanine aminotransferase (ALT) levels returned to normal in three of nine cases in whom the ALT levels were high before treatment. At the end of therapy, the mean histologic activity index score was significantly diminished (P = 0.0039). Conclusions: In conclusion, a 12 month course of IFN-alpha 2b induces some beneficial effects on virologic, biochemical and histologic indices in children with chronic hepatitis B who have previously undergone therapy for cancer