Miami, FL
July 4, 2018
Volume IX | Issue No. 27
Urinary stone risk factors in the descendants of patients with kidney stone disease
A 24-hour urinary metabolic profile of urine from 28 calcium oxalate nephrolithiasis patients and 46 of their descendants studied and compared urine analysis to a matched normal control group. Results indicate that descendants of stone forming parents have higher urinary oxalate and calcium (supersaturated in 1:5) with an elevated urinary excretion rate of calcium, phosphate, protein and albumin.
Children of adult nephrolithiasis patients carry several urinary metabolic risk factors predisposing them to stone formation similar to those of their parents. 
Positive guaiac/bloody stools and intussusception
"Currant jelly stool is a late manifestation of intussusception and is rarely seen in clinical practice." A retrospective cross sectional study cohort of all children (1,258) ages 1 month - 6 years (median age 1.7 years) diagnosed with intussusception evaluated the predictive value of gastrointestinal bleeding (positive guaiac stool test, bloody stool and rectal bleeding) in intussusception.
Blood in the stool (visible or otherwise) is a poor predictor of the presence of intussusception.
Maternal stress and fetal growth 
Multiple studies have recorded the deleterious effect of maternal anxiety, depression or stress on perinatal, short and longer term infant/child outcomes.

In June 2010-2012, 92 Swedish women were followed from conception through pregnancy and childbirth with their Perceived Stress Scale (PSS) scores, and salivary cortisol levels collected at 26-28 gestational weeks with infant birth weight being recorded.

In this study maternal stress appears not to be associated with birth weight, and as cortisol levels are inversely related to PSS score, other mechanisms for the maternal stress effects on child outcomes require further study.

See related video HERE.
Childhood Obesity Facts 
Another approach to functional constipation after failed medical management 
Childhood constipation is common and almost always functional without an organic etiology (now called disorders of gut-brain interaction; Rome IV). Most respond to treatments which include increased exercise, dietary fiber, oral laxatives, education and behavioral therapy. Unresponsive children require further evaluation (e.g. manometry) and depending on results, other managements.

A review of 31 children (median age 12 years) who failed medical management, utilized an approach which included pre-operative contrast enema, colonic manometry, a laxative protocol, colonic resection and Malone appendicostomy (appendix connected to umbilicus so a tube can be passed through it for antegrade enema administration).

10.3 months after a combination approach to chronic constipation, 32.3% of children are clean on no enema flushes, and 95.2% of those on antegrade flushes are clean with no soiling.

Pediatric phyllodes tumors 

Phyllodes (leaf-like) tumors are rare growths (<1% of breast tumors and generally in adolescents >12 years of age) that form in the periductal stromal cells of the breast. They are large tumors, tending to grow rapidly over a few weeks, and rarely spread outside the breast; most are benign, some "borderline" while others are malignant.

Though National Guidelines exist for the workup and treatment of phyllodes tumors (NCCN Guideline Version 2.2017), a study of 62 treated pediatric patients indicates that 14.5% of treatments DO NOT FOLLOW the guidelines, may be over treated and result in additional risks with limited benefits.

Video Feature
Phyllodes Tumor Definition and Treatment
Phyllodes Tumor Definition and Treatment
Preterm infant stomach protein-degrading activity

Mother's milk contains almost 200 distinct peptides. Degradation of milk proteins begins early during lactation with infant gastric samples having at least 649 milk peptides, demonstrating that digestion continues in the infant's stomach. Whether premature infants have a lower gastric protein digestive capacity is unknown.

A study which measured human milk and infant gastric samples for gastric protein digestion from 16 preterm (24-32 weeks gestational age) and 6 term (38-40 weeks gestational age) mother-infant pairs indicates that gastric protein break down in the preterm infant is significantly less than in term babies. This may impair nutrient acquisition.

Outcome of Benign Acute Childhood Myositis (BACM)

A retrospective study of 44 children (80% male), mean age 7.3 years examined the evolution of BACM and its relationship to creatine phosphokinase (CPK) values and myoglobinuria.
Acute childhood myositis is usually benign (mean CPK level: 1872 IU/L) with no abnormal neurological findings, hematuria or renal failure and no adverse outcomes on follow-up.
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