Pub Date : 2019-01-01DOI: 10.1097/MPG.0000000000002471
Anna C Tottman, J. Alsweiler, F. Bloomfield, G. Gamble, Yannan Jiang, Myra Leung, Tanya Poppe, B. Thompson, T. Wouldes, J. Harding
OBJECTIVES To determine whether a new nutrition protocol designed to increase early protein intakes while reducing fluid volume in infants born very preterm was associated with altered neurodevelopment and growth in childhood. METHODS A retrospective, observational cohort study of children born <30 weeks' gestation or <1,500 grams and admitted to the neonatal unit, National Women's Hospital, Auckland, NZ, before and after a change in nutrition protocol. The primary outcome was neurodevelopmental impairment at 7 years (any of Wechsler Intelligence Scale for Children full scale IQ<85, Movement Assessment Battery for Children-2 total score ≤5 centile, cerebral palsy, blind or deaf requiring aids). Outcomes were compared between groups and for the overall cohort using generalised linear regression, adjusted for sex and birth weight z-score. RESULTS Of 201 eligible children, 128 (64%) were assessed (55/89 (62%) exposed to the old nutrition protocol, 73/112 (65%) to the new protocol). Children who experienced the new protocol received more protein, less energy and less carbohydrate in postnatal days 1-7. Neurodevelopmental impairment was similar at 7 years (30/73 (41%) vs 25/55 (45%), adjusted odds ratio (AOR) (95% confidence interval) 0.78 (0.35-1.70), P = 0.55), as was the incidence of cerebral palsy (AOR 7.36 (0.88-61.40), P = 0.07). Growth and body composition were also similar between groups. An extra one g.kg parenteral protein intake in postnatal days 1-7 was associated with a 27% increased odds of cerebral palsy (AOR 1.27 (1.03-1.57), P = 0.006). CONCLUSIONS Higher early protein intakes do not change overall rates of neurodevelopmental impairment or growth at 7 years. Further research is needed to determine the effects of higher early parenteral protein intake on motor development.
目的:确定一种新的营养方案，旨在增加早期蛋白质摄入量，同时减少极早产儿的液体量，是否与儿童时期神经发育和生长的改变有关。方法一项回顾性、观察性队列研究，研究对象是在营养方案改变前后，出生<30周妊娠或< 1500克，并在新西兰奥克兰国立妇女医院新生儿病房住院的儿童。主要结局为7岁时神经发育障碍(韦氏儿童智力量表全量表IQ<85，儿童运动评估量表-2总分≤5分，脑瘫，需要辅助的失明或失聪)。使用广义线性回归比较各组之间和整个队列的结果，并根据性别和出生体重z评分进行调整。结果在201名符合条件的儿童中，评估了128名(64%)儿童(55/89名(62%)采用旧营养方案，73/112名(65%)采用新营养方案)。接受新方案的儿童在出生后1-7天获得了更多的蛋白质，更少的能量和更少的碳水化合物。7岁时神经发育障碍相似(30/73 (41%)vs 25/55(45%)，调整优势比(AOR)(95%可信区间)0.78 (0.35-1.70)，P = 0.55)，脑瘫发生率相似(AOR 7.36 (0.88-61.40)， P = 0.07)。各组之间的生长和体成分也相似。出生后1-7天每多摄入1 g.kg肠外蛋白，脑瘫的几率增加27% (AOR 1.27 (1.03-1.57)， P = 0.006)。结论:较高的早期蛋白质摄入量不会改变7岁时神经发育障碍或生长的总体发生率。需要进一步的研究来确定早期摄入较多的肠外蛋白质对运动发育的影响。
{"title":"Relationships Between Early Neonatal Nutrition and Neurodevelopment at School Age in Children Born Very Preterm.","authors":"Anna C Tottman, J. Alsweiler, F. Bloomfield, G. Gamble, Yannan Jiang, Myra Leung, Tanya Poppe, B. Thompson, T. Wouldes, J. Harding","doi":"10.1097/MPG.0000000000002471","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002471","url":null,"abstract":"OBJECTIVES To determine whether a new nutrition protocol designed to increase early protein intakes while reducing fluid volume in infants born very preterm was associated with altered neurodevelopment and growth in childhood. METHODS A retrospective, observational cohort study of children born <30 weeks' gestation or <1,500 grams and admitted to the neonatal unit, National Women's Hospital, Auckland, NZ, before and after a change in nutrition protocol. The primary outcome was neurodevelopmental impairment at 7 years (any of Wechsler Intelligence Scale for Children full scale IQ<85, Movement Assessment Battery for Children-2 total score ≤5 centile, cerebral palsy, blind or deaf requiring aids). Outcomes were compared between groups and for the overall cohort using generalised linear regression, adjusted for sex and birth weight z-score. RESULTS Of 201 eligible children, 128 (64%) were assessed (55/89 (62%) exposed to the old nutrition protocol, 73/112 (65%) to the new protocol). Children who experienced the new protocol received more protein, less energy and less carbohydrate in postnatal days 1-7. Neurodevelopmental impairment was similar at 7 years (30/73 (41%) vs 25/55 (45%), adjusted odds ratio (AOR) (95% confidence interval) 0.78 (0.35-1.70), P = 0.55), as was the incidence of cerebral palsy (AOR 7.36 (0.88-61.40), P = 0.07). Growth and body composition were also similar between groups. An extra one g.kg parenteral protein intake in postnatal days 1-7 was associated with a 27% increased odds of cerebral palsy (AOR 1.27 (1.03-1.57), P = 0.006). CONCLUSIONS Higher early protein intakes do not change overall rates of neurodevelopmental impairment or growth at 7 years. Further research is needed to determine the effects of higher early parenteral protein intake on motor development.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78139126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1097/MPG.0000000000002517
S. Hassan, M. T. Wolf, Luis A Umaña, Sadia Malik, N. Uddin, J. Andersen, Amal A. Aqul
Received March 14, 2019 From the Division of Nutrition, the yDivis Genetics, the §Divisio rics, and the jjDvision University of Texas S Address correspondence of Pediatric Gastroent Pediatrics, University Center, Address 193 (e-mail: amal.aqul@u Supplemental digital co citations appear in th provided in the HTM (www.jpgn.org). The authors report no co Copyright # 2019 by E Hepatology, and Nut Gastroenterology, He DOI: 10.1097/MPG.0000
{"title":"Homozygous NEK8 Mutations in Siblings with Neonatal Cholestasis Progressing to End Stage Liver, Renal and Cardiac Disease.","authors":"S. Hassan, M. T. Wolf, Luis A Umaña, Sadia Malik, N. Uddin, J. Andersen, Amal A. Aqul","doi":"10.1097/MPG.0000000000002517","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002517","url":null,"abstract":"Received March 14, 2019 From the Division of Nutrition, the yDivis Genetics, the §Divisio rics, and the jjDvision University of Texas S Address correspondence of Pediatric Gastroent Pediatrics, University Center, Address 193 (e-mail: amal.aqul@u Supplemental digital co citations appear in th provided in the HTM (www.jpgn.org). The authors report no co Copyright # 2019 by E Hepatology, and Nut Gastroenterology, He DOI: 10.1097/MPG.0000","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73328765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1097/MPG.0000000000002506
B. Raphael, G. Fournier, Sarah R. McLaughlin, M. Puder, Sarah Jones, Kelly B. Flett
BACKGROUND Patients receiving home parenteral nutrition (HPN) are at high-risk for central line associated bloodstream infections (CLABSI). However, there are no published management guidelines for the antibiotic treatment of suspected CLABSI in this population. Historical microbiology data may help inform empiric antimicrobial regimens in this population. OBJECTIVE To describe antimicrobial resistance patterns and determine the most appropriate empiric antibiotic therapy in HPN dependent children experiencing a community-acquired CLABSI. METHODS Single-center retrospective cohort study evaluating potential coverage of empiric antibiotic regimens in children on HPN who developed a community-acquired CLABSI. RESULTS From October 1, 2011 to September 30, 2017, there were 309 CLABSI episodes among 90 HPN-dependent children with median age 3.8 years-old.Fifty-nine percent of patients carried the diagnosis of surgical short bowel syndrome. Organisms isolated during these infections included 60% gram-positive bacteria, 34% gram-negative bacteria, and 6% fungi. Among all staphylococcal isolates, 51% were methicillin sensitive. Among enteric gram-negative organisms, sensitivities were piperacillin-tazobactam 71%, cefepime 97% and meropenem 99%. Organisms were sensitive to current institutional standard therapy with vancomycin + piperacillin-tazobactam in 69% of cases compared with vancomycin + cefepime or vancomycin + meropenem in 85% and 96% of cases (both p < 0.01). CONCLUSIONS Empiric antimicrobial therapy for suspected CLABSI in HPN-dependent children should include therapy for methicillin-resistant staphylococci as well as enteric gram-negative organisms. Future studies are needed to evaluate clinical outcomes based upon evidence-based antimicrobial regimens.
{"title":"Antibiotic Susceptibility and Therapy in Central Line Infections in Pediatric Home Parenteral Nutrition Patients.","authors":"B. Raphael, G. Fournier, Sarah R. McLaughlin, M. Puder, Sarah Jones, Kelly B. Flett","doi":"10.1097/MPG.0000000000002506","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002506","url":null,"abstract":"BACKGROUND Patients receiving home parenteral nutrition (HPN) are at high-risk for central line associated bloodstream infections (CLABSI). However, there are no published management guidelines for the antibiotic treatment of suspected CLABSI in this population. Historical microbiology data may help inform empiric antimicrobial regimens in this population. OBJECTIVE To describe antimicrobial resistance patterns and determine the most appropriate empiric antibiotic therapy in HPN dependent children experiencing a community-acquired CLABSI. METHODS Single-center retrospective cohort study evaluating potential coverage of empiric antibiotic regimens in children on HPN who developed a community-acquired CLABSI. RESULTS From October 1, 2011 to September 30, 2017, there were 309 CLABSI episodes among 90 HPN-dependent children with median age 3.8 years-old.Fifty-nine percent of patients carried the diagnosis of surgical short bowel syndrome. Organisms isolated during these infections included 60% gram-positive bacteria, 34% gram-negative bacteria, and 6% fungi. Among all staphylococcal isolates, 51% were methicillin sensitive. Among enteric gram-negative organisms, sensitivities were piperacillin-tazobactam 71%, cefepime 97% and meropenem 99%. Organisms were sensitive to current institutional standard therapy with vancomycin + piperacillin-tazobactam in 69% of cases compared with vancomycin + cefepime or vancomycin + meropenem in 85% and 96% of cases (both p < 0.01). CONCLUSIONS Empiric antimicrobial therapy for suspected CLABSI in HPN-dependent children should include therapy for methicillin-resistant staphylococci as well as enteric gram-negative organisms. Future studies are needed to evaluate clinical outcomes based upon evidence-based antimicrobial regimens.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86446250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.1097/MPG.0000000000002503
Jacquelin Peck, Katie Mills, A. Dey, A. T. Nguyen, E. Amankwah, Alexander Wilsey, Emily Swan, Sorany Son, Sara Karjoo, D. McClenathan, M. Wilsey
BACKGROUND Enteral nutrition is commonly initiated 24-hours after percutaneous endoscopic gastrostomy (PEG) in children. Adult studies report safe refeeding within 1-6 hours of PEG and these findings have been cautiously applied to children. However, comparative studies assessing early vs next-day refeeding in children are currently lacking. This study evaluates feeding tolerance and complications following early vs. next-day refeeding in children. METHODS This is a single-center, pre-post study. In June 2015 our clinical practice changed to begin refeeding within 6-hours of PEG. Children receiving early refeeding from December 2015 to August 2017 were included. A retrospective cohort from February 2013 to April 2015 was used for comparison. RESULTS 46 children received early refeeding after PEG and 37 received next-day refeeding. Gender distribution was similar in the two groups. Early refeeding patients were slightly older (3.5 vs. 2.2 years) and heavier (15.5 kg vs. 11.5 kg) at PEG placement compared to next-day refeeding patients. Early Refeeding patients experienced greater post-procedural nausea and/or vomiting (19% vs 8%, p < 0.001) and leakage, irritation, and infection around the stoma (19% vs 0.0%, p < 0.001). Compared to Early Refeeders, Next-Day Refeeding patients experienced higher occurrence of fever (35% vs 13%, p = 0.021), longer nutritional disruption (24.6 vs 3.7 hours, p < 0.001) and longer length of stay (51 vs. 27 hours; p < 0.001). One Next-Day-Refeeding patient experienced peritonitis. One Early Refeeding patient experienced cellulitis requiring hospitalization and a second experienced gastrostomy tube migration into the peritoneal cavity requiring removal. CONCLUSION Early Refeeders experienced higher rates of post-procedural nausea or vomiting and irritation, leakage or infection around the stoma; but experienced lower rates of post-operative fever. Early refeeding resulted in reduced nutritional interruption and hospital length of stay.
背景:儿童经皮内镜胃造口术(PEG)后24小时开始肠内营养。成人研究报告在PEG 1-6小时内安全再喂养，这些发现已谨慎地应用于儿童。然而，目前缺乏评估儿童早期和第二天再喂养的比较研究。本研究评估了儿童早期和第二天再喂养后的喂养耐受性和并发症。方法本研究为单中心、前后研究。2015年6月，我们的临床实践改为在PEG 6小时内开始重新喂食。纳入2015年12月至2017年8月期间接受提前再喂养的儿童。采用2013年2月至2015年4月的回顾性队列进行比较。结果术后早期再喂养46例，次日再喂养37例。两组的性别分布相似。与次日再喂养的患者相比，早期再喂养的患者在PEG放置时年龄稍大(3.5岁对2.2岁)，体重更重(15.5 kg对11.5 kg)。早期再喂养患者术后恶心和/或呕吐更严重(19%对8%，p < 0.001)，造口周围渗漏、刺激和感染更严重(19%对0.0%，p < 0.001)。与早期再喂养者相比，第二天再喂养患者出现更高的发热发生率(35% vs 13%， p = 0.021)，更长的营养中断(24.6 vs 3.7小时，p < 0.001)和更长的住院时间(51 vs 27小时;p < 0.001)。1例次日再喂养患者出现腹膜炎。一名早期再喂养患者出现蜂窝织炎需要住院治疗，另一名患者出现胃造口管迁移到腹膜腔需要切除。结论早期再喂食者术后恶心、呕吐及造口周围刺激、渗漏或感染发生率较高;但术后发热率较低。早期再喂养减少了营养中断和住院时间。
{"title":"Comparison of Tolerance and Complication Rates between Early and Delayed Feeding after PEG Placement in Children.","authors":"Jacquelin Peck, Katie Mills, A. Dey, A. T. Nguyen, E. Amankwah, Alexander Wilsey, Emily Swan, Sorany Son, Sara Karjoo, D. McClenathan, M. Wilsey","doi":"10.1097/MPG.0000000000002503","DOIUrl":"https://doi.org/10.1097/MPG.0000000000002503","url":null,"abstract":"BACKGROUND Enteral nutrition is commonly initiated 24-hours after percutaneous endoscopic gastrostomy (PEG) in children. Adult studies report safe refeeding within 1-6 hours of PEG and these findings have been cautiously applied to children. However, comparative studies assessing early vs next-day refeeding in children are currently lacking. This study evaluates feeding tolerance and complications following early vs. next-day refeeding in children. METHODS This is a single-center, pre-post study. In June 2015 our clinical practice changed to begin refeeding within 6-hours of PEG. Children receiving early refeeding from December 2015 to August 2017 were included. A retrospective cohort from February 2013 to April 2015 was used for comparison. RESULTS 46 children received early refeeding after PEG and 37 received next-day refeeding. Gender distribution was similar in the two groups. Early refeeding patients were slightly older (3.5 vs. 2.2 years) and heavier (15.5 kg vs. 11.5 kg) at PEG placement compared to next-day refeeding patients. Early Refeeding patients experienced greater post-procedural nausea and/or vomiting (19% vs 8%, p < 0.001) and leakage, irritation, and infection around the stoma (19% vs 0.0%, p < 0.001). Compared to Early Refeeders, Next-Day Refeeding patients experienced higher occurrence of fever (35% vs 13%, p = 0.021), longer nutritional disruption (24.6 vs 3.7 hours, p < 0.001) and longer length of stay (51 vs. 27 hours; p < 0.001). One Next-Day-Refeeding patient experienced peritonitis. One Early Refeeding patient experienced cellulitis requiring hospitalization and a second experienced gastrostomy tube migration into the peritoneal cavity requiring removal. CONCLUSION Early Refeeders experienced higher rates of post-procedural nausea or vomiting and irritation, leakage or infection around the stoma; but experienced lower rates of post-operative fever. Early refeeding resulted in reduced nutritional interruption and hospital length of stay.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84115647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-01-01DOI: 10.1097/MPG.0000000000001095
Eva Bruloy, E. Haraux, B. Robert, D. Djeddi, P. Buisson
JP ratory tests were normal. Abdominal ultrasound showed a large amount of ascites. mature lymphocytes. Magnetic resonance imaging revealed clumped bowel loops overlying the spine and the complete absence of ascites between bowel loops and around the liver. Bowel loops were displaced by intraperitoneal, multiloculated, septated T1and T2-hyperintense soft tissue corresponding to venous blood (Fig. 1). Laparotomy revealed a giant cystic lymphangioma of the greater omentum (Fig. 2). The patient is doing well 24 months after surgery with no signs of recurrence.
{"title":"Unusual Presentation of Giant Omental Cystic Lymphangioma Mimicking Hemorrhagic Ascites in a Child.","authors":"Eva Bruloy, E. Haraux, B. Robert, D. Djeddi, P. Buisson","doi":"10.1097/MPG.0000000000001095","DOIUrl":"https://doi.org/10.1097/MPG.0000000000001095","url":null,"abstract":"JP ratory tests were normal. Abdominal ultrasound showed a large amount of ascites. mature lymphocytes. Magnetic resonance imaging revealed clumped bowel loops overlying the spine and the complete absence of ascites between bowel loops and around the liver. Bowel loops were displaced by intraperitoneal, multiloculated, septated T1and T2-hyperintense soft tissue corresponding to venous blood (Fig. 1). Laparotomy revealed a giant cystic lymphangioma of the greater omentum (Fig. 2). The patient is doing well 24 months after surgery with no signs of recurrence.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75880848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-11-01DOI: 10.1097/MPG.0000000000001070
Izabella Łazowska-Przeorek, D. Kąkol, K. Karolewska-Bochenek, A. Banaszkiewicz
e A 3-month-old girl was admitted for suspected upper gastrointestinal (GI) tract bleeding and emesis. She had 3 weeks of regurgitation and 3 days of daily emesis, t weight from the 50th to the 25th percentile. Omeprazole was started on admission. doscopy revealed a ‘‘cobblestone’’ appearance of the esophagus (Fig. 1). Biopsies revealed severe esophagitis (no eosinophils) with ulceration and partial necrosis of the mucosa in the distal esophagus. Upper GI series revealed an enormous stomach with suspicion of infantile hypertrophic pyloric stenosis, confirmed by sonography. She underwent open pyloroplasty with no further emesis and regained her weight quickly. Repeat upper endoscopy at 12 weeks revealed a completely normal esophagus. Biopsies showed mild distal esophagitis. ‘‘Cobblestone esophagitis’’ is a rare endoscopic finding and has been associated with eosinophilic esophagitis, candidiasis, and Barrett esophagus in adults (1–3). It can also be found in severe reflux esophagitis secondary to distal GI obstruction, as in our case. Our patient had an atypical presentation of pyloric stenosis, with no history of projectile vomiting or persistent hunger (4).
{"title":"\"Cobblestone\" Appearance of Esophagus: An Unusual Symptom of Pyloric Stenosis.","authors":"Izabella Łazowska-Przeorek, D. Kąkol, K. Karolewska-Bochenek, A. Banaszkiewicz","doi":"10.1097/MPG.0000000000001070","DOIUrl":"https://doi.org/10.1097/MPG.0000000000001070","url":null,"abstract":"e A 3-month-old girl was admitted for suspected upper gastrointestinal (GI) tract bleeding and emesis. She had 3 weeks of regurgitation and 3 days of daily emesis, t weight from the 50th to the 25th percentile. Omeprazole was started on admission. doscopy revealed a ‘‘cobblestone’’ appearance of the esophagus (Fig. 1). Biopsies revealed severe esophagitis (no eosinophils) with ulceration and partial necrosis of the mucosa in the distal esophagus. Upper GI series revealed an enormous stomach with suspicion of infantile hypertrophic pyloric stenosis, confirmed by sonography. She underwent open pyloroplasty with no further emesis and regained her weight quickly. Repeat upper endoscopy at 12 weeks revealed a completely normal esophagus. Biopsies showed mild distal esophagitis. ‘‘Cobblestone esophagitis’’ is a rare endoscopic finding and has been associated with eosinophilic esophagitis, candidiasis, and Barrett esophagus in adults (1–3). It can also be found in severe reflux esophagitis secondary to distal GI obstruction, as in our case. Our patient had an atypical presentation of pyloric stenosis, with no history of projectile vomiting or persistent hunger (4).","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87520617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-10-01DOI: 10.1097/MPG.0000000000001064
Jordan Weitzner, Jacob Bilhartz, J. Magliocca, A. J. Freeman
FIGURE 1. Axial T2 MRI image of the largest cyst in the right lobe of the liver with 2 additional daughter cysts present within the large cyst. Also partially visible are 2 additional cysts present in the left lobe. MRI1⁄4magnetic resonance imaging. FIGURE 2. Gross anatomical specimen of the large cyst shown on MRI with 1 daughter cyst present. Normal liver parenchyma is seen adjacent to the cyst. MRI1⁄4magnetic resonance imaging.
{"title":"Cystic Echinococcus Infection in a 10-Year-Old Iraqi Refugee.","authors":"Jordan Weitzner, Jacob Bilhartz, J. Magliocca, A. J. Freeman","doi":"10.1097/MPG.0000000000001064","DOIUrl":"https://doi.org/10.1097/MPG.0000000000001064","url":null,"abstract":"FIGURE 1. Axial T2 MRI image of the largest cyst in the right lobe of the liver with 2 additional daughter cysts present within the large cyst. Also partially visible are 2 additional cysts present in the left lobe. MRI1⁄4magnetic resonance imaging. FIGURE 2. Gross anatomical specimen of the large cyst shown on MRI with 1 daughter cyst present. Normal liver parenchyma is seen adjacent to the cyst. MRI1⁄4magnetic resonance imaging.","PeriodicalId":16725,"journal":{"name":"Journal of Pediatric Gastroenterology & Nutrition","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86622746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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