@article {10559, title = {Acute Abdominal Pain: Recognition and Management of Constipation in the Emergency Department.}, journal = {Pediatr Emerg Care}, volume = {33}, year = {2017}, month = {2017 Oct}, pages = {e75-e78}, abstract = {

OBJECTIVE: The main aim of the study was to investigate the incidence and the clinically relevant features of functional constipation in patients evaluated for acute abdominal pain in a tertiary care pediatric emergency department.

METHODS: This is a retrospective study. We analyzed 4394 medical records and recorded the information (demographics, triage code, symptoms, medical history, physical evaluation, laboratory tests, radiological studies, procedures, and treatments) of all patients admitted for acute abdominal pain to the emergency department of the IRCCS Burlo Garofolo, Trieste, during 2010 to 2013.

RESULTS: In this study, a quarter of patients (1020) presenting in the emergency department with acute abdominal pain were affected by functional constipation. Acute pain associated with functional constipation is generally rated from moderate to severe, and the location of the pain on physical evaluation was not a sufficient criterion to guide diagnosis. Isolated vomiting may be present in a minority of cases. Digital rectal exploration was never performed; the majority of patients were treated by means of an enema with prompt relief. Six percent of patients with constipation underwent radiological studies.

CONCLUSIONS: This study confirms that the medical history provides a pivotal role in the diagnosis of functional constipation. Digital rectal exploration and x-rays should be avoided in this setting, whereas an enema plays a useful diagnostic and therapeutic role in our study patients.

}, keywords = {Abdominal Pain, Acute Pain, Adolescent, Child, Child, Preschool, Constipation, Emergency Service, Hospital, Enema, Female, Humans, Incidence, Infant, Male, Retrospective Studies}, issn = {1535-1815}, doi = {10.1097/PEC.0000000000001039}, author = {Norbedo, Stefania and Bassanese, Giulia and Barbieri, Francesca and Barbi, Egidio} } @article {8492, title = {"Safety and utility of percutaneous liver biopsy in hematopoietic stem cell transplant pediatric recipients: a retrospective study".}, journal = {BMC Cancer}, volume = {16}, year = {2016}, month = {2016}, pages = {590}, abstract = {

BACKGROUND: Liver biopsies in pediatric hematopoietic stem cell transplantation (HSCT) patients are as and effective when performed at bedside in the Bone Marrow Transplant Unit (BMTU) than in the Day Surgery Unit (DSU), with better patient compliance and lower emotional distress for these children.

METHODS: The study group consisted of 45 children who underwent allogeneic HSCT. We reviewed 68 liver biopsies performed between April 2006 and September 2015. 12 (17.6~\%) biopsies were performed in the DSU and 56 (82.3~\%) in the BMTU; nine (13.2~\%) prior to HSCT and 59 (86.7~\%) after HSCT. Pre-procedural behavioral status (subjective score) was evaluated by pediatric transplant physicians by filling in a questionnaire employing a three-point scale: "calm and cooperative", "agitated and non-cooperative" or "frightened and suffering". Objective score was obtained measuring patient{\textquoteright}s heart rate before the procedure and comparing it with mean heart rate.

RESULTS: Patients who underwent the procedure at the BMTU experienced less emotional distress than those who underwent it in the DSU: 58.3~\% of patients treated at the DSU were agitated as compared with 16.1~\% of those treated at the BMTU (p < 0.01). Among the 59 biopsies performed after HSCT, 41 (69.5~\%) were taken from symptomatic patients for a diagnostic purpose and 18 (30.5~\%) in asymptomatic ones in order to rule out hepatic GVHD. Among these 18 procedures, GVHD was diagnosed in 16 (88.9~\%) cases. Minor complications occurred in about 17~\% of procedures (12 biopsies), at a rate of 25~\% for the DSU location compared with 16~\% for the BMTU location. Only two major complications were reported, one in the DSU and one in the BMTU.

CONCLUSION: Liver biopsy performed at bedside in HSCT patients does not carry a higher risk of adverse events than the same procedure performed in the DSU and has lower emotional distress associated with better patient compliance, thus contributing significantly to a higher standard of care.

}, issn = {1471-2407}, doi = {10.1186/s12885-016-2603-8}, author = {Maximova, Natalia and Gregori, Massimo and Barbieri, Francesca and Pizzol, Antonio and Sonzogni, Aurelio} } @article {3475, title = {Hemophagocytic lymphohistiocytosis in total parenteral nutrition dependent children: description of 5 cases and practical tips for management.}, journal = {J Pediatr Hematol Oncol}, volume = {36}, year = {2014}, month = {2014 Oct}, pages = {e440-2}, abstract = {

Although total parenteral nutrition (TPN) is mandatory in children with intestinal failure, this treatment is not risk free. The main complications of TPN include catheter-related sepsis, thrombosis, hepatic cholestasis and cirrhosis, metabolic bone disease, and, rarely, reactive hemophagocytic lymphohistiocytosis (HLH). The pathogenesis of HLH in patients with TPN is not known, although some authors hypothesized that it can result from the activation of macrophages because of "fat overload." We reported 5 cases of HLH that occurred in patients with 4 different underlying disorders, all requiring TPN for a long term. In our series, an underlying immunological defect or a serious infection (sepsis) can have triggered HLH. Therefore, it could be reasonable to hypothesize that besides TPN in itself, minor immune defects and infections may act together by overcoming a threshold of immune stimulation, which ultimately leads to HLH.

}, keywords = {Child, Preschool, Fatty Acids, Female, Humans, Infant, Intestinal Diseases, Lymphohistiocytosis, Hemophagocytic, Male, Parenteral Nutrition, Total, Steroids, Treatment Outcome}, issn = {1536-3678}, doi = {10.1097/MPH.0b013e31829f381b}, author = {Pastore, Serena and Barbieri, Francesca and Di Leo, Grazia and Valencic, Erica and Tommasini, Alberto and Ventura, Alessandro} }