Thiamine deficiency in children with congenital heart disease before and after corrective surgery

BACKGROUND

Malnutrition is common in children with congenital heart disease, while thiamine deficiency (TD) is common in malnutrition, in critically ill children, and in adults with congestive heart failure treated with loop diuretics. Our goal was to determine whether children with congenital heart disease had TD and whether treatment with loop diuretics is related to TD in these patients.

METHODS

Twelve children with ventricular septal defect (VSD) treated with furosemide, and 10 children with tetralogy of Fallot (TOF) referred for corrective surgery were consecutively enrolled into a prospective study. Data were collected 24 hours before surgery and 5 days after surgery for nutrition evaluation, medications used, anthropometric measurements, and laboratory markers of malnutrition. Thiamine and pyridoxine deficiencies were evaluated using activated enzyme assays.

RESULTS

Seven children (32% of patients) did not meet the recommended daily allowance (RDA) for calories and 18% of patients did not meet the RDA for thiamine intake. Anthropometric measurements were low in both groups, more so in those with VSD, although the difference did not reach statistical significance. Overall, 18% (1/12 with VSD and 3/10 with TOF) of children with congenital heart disease had thiamine deficiency before surgery. Three of the four children with TD had adequate intake of thiamine. Six children (27%) had TD 5 days postsurgery (3 children with VSD and 3 children with TOF).

CONCLUSIONS

TD is common in children with congenital heart disease (CHD) referred for corrective surgery both before and after surgery. Our results suggest that neither diuretic treatment nor malnutrition can fully explain the development of TD in these children.

Budesonide versus prednisone in the treatment of active Crohn's disease. The Israeli Budesonide Study Group

BACKGROUND & AIMS

Budesonide (BUD) is a potent steroid that undergoes extensive first-pass metabolism. BUD incorporated in a pH-dependent formulation has been proposed as an alternative treatment for Crohn's disease (CD). The aim of this study was to compare the efficacy and safety of BUD and prednisone (PRED) in the treatment of active CD involving the terminal ileum and/or the colon.

METHODS

Patients with mild to moderately active CD were included in a randomized, double-blind, double-dummy controlled trial. Patients received either 9 mg BUD once daily for 8 weeks or 40 mg PRED once daily for the first 2 weeks tapered gradually to 5 mg/day by the end of the study. Disease activity, quality of life, and laboratory parameters were recorded.

RESULTS

One hundred patients received BUD, and 101 patients received PRED. By intention-to-treat analysis, treatment efficacy defined as Crohn's Disease Activity Index of <150 at completion was 51% and 52.5% for the BUD and PRED groups, respectively. Twice as many responded to treatment with no side effects in the BUD compared with the PRED group (30% vs. 14%) (P = 0.006). Most of the decrease in CDAI scores occurred during the first 2 weeks.

CONCLUSIONS

BUD is as effective as PRED in the treatment of CD involving the terminal ileum and right colon. BUD has significantly fewer steroid-related adverse reactions.

The regional cerebral blood flow in familial dysautonomia

Regional cerebral blood flow (rCBF) was measured during rest by the Xenon 133 inhalation method in 8 patients with familial dysautonomia (FD). The rCBF data were compared with those obtained in a group of 55 age-matched normal subjects. In 5 moderately affected patients there was a significant increase in the rCBF, while in one severely affected female, rCBF was markedly decreased. In two mildly affected patients, rCBF was normal and similar to controls. It is suggested that the increases in rCBF in FD may compensate for a yet undetermined autoregulatory failure of cerebral vasculature.

Growth effect of human chorionic gonadotrophin in 2-8-year-old boys with undescended testes

Growth-promoting effect of human chorionic gonadotrophin (HCG) was studied in 40 boys of 2-8 years with unilateral undescended testes. A transient acceleration of height and weight increase was noted that exceeded rates found in normal puberty. No significant advance in bone age was noted following treatment. On the basis of this study we conclude that short-term HCG treatment does not change the growth pattern or bone age of 2-8-year-old boys.