{"title":"Chronic Active Hepatitis and Related Disorders","authors":"Victor Larcher","doi":"10.1016/S0300-5089(21)00678-7","DOIUrl":"https://doi.org/10.1016/S0300-5089(21)00678-7","url":null,"abstract":"<div><p>Chronic hepatitis in children should be suspected if clinical features and abnormal liver function tests persist for over one month following an episode of acute hepatitis, in children who present with relapsing hepatitis, or those presenting coincidentally with features of chronic liver disease. Specific investigation must be undertaken to define aetiology. For example, hepatitis B, Wilson's disease and α<sub>1</sub>-antitrypsin deficiency must be excluded. Early histological diagnosis by an experienced histopathologist is mandatory.</p><p>Chronic persistent hepatitis requires no therapy, but careful follow-up is desirable, especially for hepatitis B-positive cases. If the histological appearances are those of chronic active hepatitis, distinction between HBVassociated and autoimmune varieties is necessary. Autoimmune CAH in children differs from that in adults in that the onset is often acute, response to immunosuppressants usually favourable, and withdrawal of therapy may be successful, especially if diagnosis is established early before serious liver damage occurs. Evidence is presented to suggest that autoimmune CAH is associated with a genetic predisposition to autoimmune disease, characterized by both antigen-specific and antigen-independent T suppressor cell defects. An antibody-dependent non-T cell cytotoxicity operates against liver cell surface antigens. HBV CAH, on the other hand, may respond poorly to immunosuppressants and appropriate therapeutic regimens are not defined.</p><p>There is some evidence to suggest that early diagnosis and institution of therapy in autoimmune CAH may lessen the incidence of cirrhosis on follow-up. Further studies to understand the interaction between hepatocytes, inflammatory cells and non-parenchymal cells in the process of hepatic fibrosis may provide the means of active intervention in this area in the future.</p></div>","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 1","pages":"Pages 173-198"},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136603487","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}
{"title":"Intestinal motility and its disorders.","authors":"P J Milla","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 1","pages":"121-36"},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14636544","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}
{"title":"Abnormalities of the biliary tree.","authors":"K R Kamath","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 1","pages":"157-72"},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14636545","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}
{"title":"Bacterial diarrhoea.","authors":"M Gracey","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Bacterial infections are important causes of diarrhoea in infants and children, particularly in developing countries and in other settings where standards of personal and community hygiene are low. Knowledge of bacterial diarrhoeas has been significantly expanded in recent years by the finding that many episodes of acute diarrhoea are due to infections with bacteria which produce enterotoxins that interfere with intestinal fluid and electrolyte transport (the 'enterotoxigenic' diarrhoeas). Several 'newer' bacterial agents have also been identified which would not have been detected in earlier studies of the epidemiology of infective diarrhoeas; these include Aeromonas, Campylobacter, Clostridium difficile and Yersinia. Another important advance has been new knowledge about mechanisms by which bacteria cause diarrhoea; this has led to the widespread successful application of oral rehydration therapy in treatment of acute watery diarrhoeas.</p>","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 1","pages":"21-37"},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14636546","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}
V.L. Soutter, P. Kristidis, M.A. Gruca, K.J. Gaskin
{"title":"Chronic Undernutrition/Growth Retardation in Cystic Fibrosis","authors":"V.L. Soutter, P. Kristidis, M.A. Gruca, K.J. Gaskin","doi":"10.1016/S0300-5089(21)00676-3","DOIUrl":"https://doi.org/10.1016/S0300-5089(21)00676-3","url":null,"abstract":"<div><p>There is now sufficient evidence to prove that the maintenance of a high energy normally balanced diet prevents malnutrition/growth retardation and may well enhance prognosis in patients with CF. Most patients are able to tolerate the normal to high fat content without undue problems with steatorrhoea and with the recent advent of more effective enzyme replacement therapy, this should be even less of a problem. Conversely, there is an equally large bulk of evidence to indicate that the maintenance of a low fat diet, while controlling symptoms from steatorrhoea in some patients, is energy depriving and produces growth failure.</p><p>In children or teenagers who are presently growth retarded, installation of a high energy intake may improve growth in some, but not in others. Further investigation of the latter patients is required to evaluate their persistent anorexia and advantages and disadvantages of nutritional supplementation by invasive techniques. Certainly growth and wellbeing can be vastly improved. However, such studies may well have to be multicentred to obtain sufficient patients to control for the many variables involved, in order to demonstrate the effects on pulmonary function.</p></div>","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 1","pages":"Pages 137-155"},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136603488","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}
{"title":"Abnormalities of the Biliary Tree","authors":"K. Ramanand Kamath","doi":"10.1016/S0300-5089(21)00677-5","DOIUrl":"https://doi.org/10.1016/S0300-5089(21)00677-5","url":null,"abstract":"","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 1","pages":"Pages 157-172"},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136603489","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}
{"title":"Chronic inflammatory bowel disease.","authors":"I R Sanderson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Chronic inflammatory bowel disease in children includes Crohn's disease, ulcerative colitis, indeterminate colitis and Behçet's colitis. The reported incidence of Crohn's disease has increased in the last 30 years. The clinical features of Crohn's disease are most commonly abdominal pain and poor weight gain, whereas those of ulcerative colitis are diarrhoea and rectal bleeding. Treatment is with drugs (sulphasalazine, local or systemic steroids, azathioprine), elemental diet or surgery. The prognosis of chronic inflammatory bowel disease in childhood is good.</p>","PeriodicalId":75717,"journal":{"name":"Clinics in gastroenterology","volume":"15 1","pages":"71-87"},"PeriodicalIF":0.0,"publicationDate":"1986-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14006337","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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