Biomedical subjects
E Kawakami
Publications and source records attributed to E Kawakami.
A new, simple route to tetracyclic intermediates for the synthesis of diterpenoid alkaloids.
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Triple therapy with clarithromycin, amoxicillin and omeprazole for Helicobacter pylori eradication in children and adolescents.
BACKGROUND: Helicobacter pylori infection presents high prevalence in developing countries, but there are few pediatric assays evaluating antimicrobial treatment. OBJECTIVE: The aim of this study was to investigate Helicobacter pylori eradication rate using a short regimen (7 and 10 days) of triple therapy with clarithromycin, amoxicillin and omeprazole. PATIENTS AND METHODS: Twenty-five Hp positive patients who presented severe epigastralgia, were submitted to antimicrobial treatment with amoxicillin (50 mg/kg/day--maximum dose 1 g bid), clarithromycin (30 mg/kg/day--maximum dose 500 mg bid) and omeprazole (0.6 mg/kg/day--maximum dose 20 mg bid) during 7 or 10 days. After 2 months, clinical symptoms were evaluated and gastric biopsies were taken to test Hp eradication. RESULTS: Overall eradication rate was achieved in 16/25 patients (64%--IC(95% = 45-83%), in 11/15 (73%--IC(95%) = 51-95%) patients who used 10 days therapy course and in 5/10 (50%--IC(95%) = 19-81%) who used 7 days therapy course. Eradication drugs were well accepted and adverse effects were reported in two patients (8%). CONCLUSIONS: This triple therapy regimen had moderate efficacy (64%). The data suggests that 10 days therapy course achieves better eradication rate (73%) than 7 days course (50%) to treat Hp infection in our population.
Gastroduodenal lesions in children with juvenile rheumatoid arthritis.
BACKGROUND/AIMS: There are few studies about gastrointestinal abnormalities in patients with juvenile rheumatoid arthritis-probably due to the fact that this association is not frequently recognized. The aim of our study was to observe the prevalence of endoscopic gastroduodenal lesions in these patients. METHODOLOGY: Fourteen patients with juvenile rheumatoid arthritis, all of them using non-steroidal anti-inflammatory drugs associated or not with methotrexate, were assessed clinically and by endoscopy. Gastric antrum biopsy and Helicobacter pylori search were also performed. RESULTS: The mean age of the patients was 10.6 years (7 boys). Abdominal pain was observed in 27% of them. Macroscopic endoscopic lesions were found in 43% and infection by Helicobacter pylori in 57%. The correlation between anemia and endoscopic abnormalities was statistically significant (p < 0.05). CONCLUSIONS: Our data show that patients with juvenile rheumatoid arthritis have considerable susceptibility to gastroduodenal lesions, especially if they are using any drug association and present anemia.
[Bronchial asthma and duodenal ulcer and erosive bulbo-duodenitis in children: report of 6 cases].
The coexistence of moderate and severe asthma and duodenal ulcer is not very well established as yet. We started a protocol trying to establish the presence of reflux esophagitis in children with moderate or severe asthma. Thirty two patients underwent upper digestive endoscopy and, surprisingly, we found six children (18.7%) with the following digestive aspects: four children had duodenal ulcer, and two had erosive duodenitis. We report these cases and discuss some etiopathogenic aspects about these possible association, and beware the clinician to pay attention to abdominal pain in children with bronchial asthma.
[Physiology of intestinal transport of electrolytes. A Review].
Some physiologic aspects of the electrolyte ion transport across the intestinal mucosa regarding mechanism of absorption and secretion of water and electrolytes in the secretory diarrhea is described. Further on the role of the intracellular mediators in this transport is also related.
[Celiac disease associated with insulin-dependent diabetes mellitus: report of a case].
We report the association of diabetes mellitus and celiac disease in one patient, which was confirmed by intestinal biopsy, the withdraw of gluten from the diet, and by a positive challenge test. We emphasize the importance to recognize this association to improve the clinical management of patients with diabetes mellitus.
[Efficiency of D-xilose and triglycerides absorption tests in the investigation of chronic diarrhea].
The D-xylose and triglyceride absorption tests have been widely used as screening tests to characterize malabsorption and indicate intestinal biopsy. In this paper we report the efficiency of these tests in the differential diagnosis of the various causes of chronic diarrhea and their possible relationship to jejunal villous atrophy. Two hundred and fifteen children with chronic diarrhea were submitted to the D-xylose and triglyceride absorption tests, and small intestinal biopsy. The patients were divided into 5 groups, that is: I--celiac disease, 53; II--protracted diarrhea, 24; III--environmental enteropathy, 50: IV--celiac disease under gluten free diet, 11; V--irritable bowel syndrome, 77. D-xylose and triglyceride absorption tests were within normal limits in 3.8% and 4.2% patients belonging respectively to groups I and II. On the other hand, only 7.8% of the patients belonging to group V would be included in the group of patients that would have indication for intestinal biopsy, since both tests revealed abnormal results. Moreover, both tests showed an excellent relationship with the intensity of villous atrophy.
[Menetrier's disease in children: report of 3 cases and review of the literature].
Three cases of Ménétrier's disease in childhood are reported and 38 other cases previously described in the literature are reviewed. The disease manifests in children as a protein-losing gastropathy and a characteristic hypertrophic gastric rugae is demonstrated by upper gastrointestinal radiographs or endoscopy. In contrast to the usual chronicity of the disease in adults, the course is usually benign in children and the symptoms resolve spontaneously in weeks or months. The possible etiology and differential diagnosis are discussed. Ménétrier's disease in children may be more common than report.
[Visceral larva migrans in childhood: report of 2 cases].
Reports of Visceral larva migrans (VLM) are not frequent in Brazil, but the prevalence of this disease may be more common due to poor environmental conditions to which most of the children are exposed. The most common infectious agent is Toxocara canis, a parasite of the intestinal tract of dogs. Children get infected eating contaminated material with feces of dogs. The ova are swallowed and reach the intestinal lumen of the children. Systemic migration occurs by lymphatic or portal circulation to several organs, most frequently, to the liver and lungs, causing hepatosplenomegaly and/or bronchospasm.
[Congential malabsorption of glucose and galactose in 2 brothers].
Congeneeital glucose-galactose malabsorption is a rare clinical entity transmitted by autossomic recessive gen. The defect is in the small intestinal active transport system which is shared by glucose and galactose. Diarrhea and failure to thrive from the first week of life are the prominent symptoms. We report two sibs from consaguineous parents with diarrhea and failure to thrive since they were born. Both children had glucose and galactose malabsorption but tolerated well formula containing fructose as the only source of carbohydrate. They showed flat blood glucose curves when tested with glucose and galactose loads but normal increments of the sugar blood levels with fructose load. The small intestinal biopsy performed in both patients revealed normal villous pattern. When put under a diet containing fructose as the only source of carbohydrate, both patients had their symptoms subsided and reassumed the normal pattern of growth.
[Transepithelial transport of water, sodium, and glucose of oral hydration solutions in jejunal loops of rats undergoing "in vivo" perfusion].
There are several different oral hydration solutions of variable composition commercially available besides WHO 90. The purpose of this paper was to establish the type of solution more favorable to hydroelectrolytic transport. Water, Na and glucose transport of oral hydration solutions were measured by analysis of 728 samples from perfusions with 7 different solutions in jejunal loops of rats "in vivo". The following solutions were studied: homemade (96), Rehidrat (96), Hydrax (104), WHO 90 (104), WHO 60 (112), Pedyalite 30 (104), Pedyalite 90 (112) and a control solution (144). Hypotonic solutions with a molar ratio Na/glucose 2:1, had the greatest water absorption (homemade and WHO 60), while the solution with 90 mEq/L of Na had the greatest absorption of this ion (Pedyalite 90, WHO 90). Regarding glucose transport, Pedyalite 90 promoted the greater absorption (25 g/L). Solution with 30 mEq/L of Na and high osmolality resulted in water and Na secretion (Pedyalite 30).
[Evaluation of small intestine mucosal biopsies obtained simultaneously by suction capsule and endoscopic forceps in children with suspected enteropathy].
The aim of the study was to compare biopsy specimens obtained by suction with those obtained by endoscopy morphometrically and histologically in order to evaluate their adequacy for histological interpretation. For this, 23 children with suspected enteropathy underwent upper gastrointestinal endoscopy. For histological evaluation, biopsies were assessed for orientation, depth, length, presence of Brunner's glands and/or lymphoid follicles and presence of artifact. The mucosa total height and villi height were evaluated for morphometric assessment. The results of all the analysed parameters were not statistically significant, except for the presence of Brunner's glands that were most evident in endoscopic biopsies. Although, the suction capsule biopsies and the endoscopic ones were appropriate for histological interpretation in 91.3% respectively, the difference was not statistically significant. Based on the morphometric analysis, the mucosa total height and the villi height values in both biopsy techniques were not statistically significant different. The small intestine mucosal biopsies obtained by endoscopy compared with those obtained by suction capsule were adequate for histological interpretation.
[Primary gastritis associated with Helicobacter pylori in children].
The aim of this paper was to investigate whether a correlation between dyspeptic symptoms and infection due to Helicobacter pylori could be established. We conducted a prospective study with 27 children who had Helicobacter pylori associated antral gastritis with endoscopic and histologic alterations, without any other peptic lesions. Helicobacter pylori was detected by rapid urease test and histology with hematoxylin and eosin and Giemsa stain. Endoscopy revealed antral nodularities in 20/27 (74%) and enantema in six cases (23%). During histological examination active chronic superficial gastritis was confirmed in 26 cases (96%). Twenty seven children were treated with antimicrobial therapy, eight of which presented infection eradication, six presented nodularities regression and symptoms remission in four. Of the 19 non-eradicated patients, eight (42%) became asymptomatic and 11 maintained symptoms. Statistical analysis to compare symptoms remission was not significant. Taking into account the results presented herewith, we concluded that antral nodularity was the most common endoscopic finding, and there was no sufficient evidence of a correlation between Helicobacter pylori infection and dyspeptic symptoms.