Recent advances in pediatric medicine have led to increasing numbers of severely disabled children who require medical care at home. Severely disabled children were defined as those who have or are at increased risk of having a chronic physical and developmental condition. On April 1, 2015, we conducted a survey of these children aged 18 years or younger living in the Saku region of Nagano Prefecture. Forty severely disabled children were identified in the Saku region, accounting for 0.02% of the population. Thirty children were being cared for at home and 10 had been institutionalized. The underlying illness or disorder occurred in the perinatal period in 21 children (52.5%). We further investigated the medical care and social support of those severely disabled children living at home. There were 8 children with an extremely severe disability and 7 with a moderately severe disability. Fifteen children did not fall into either category. One patient regularly received medical examination and care via visiting serv­ices and the remaining patients received outpatient care. Visiting nurses provided support and care for 10 children (33%), especially those who needed medical care, such as for tracheostomy and gastrostomy. Thirteen children (43.3%) used a short-stay service, and 19 children (63%) used outpatient support (after-school daycare service/day care service for holidays). Short-stay facilities and child day care services are lacking. The custody support system needs to be enhanced in this region for children and their family members to lead healthy lives.

  We demonstrated the clinical features and outcome of 87 children with idiopathic thrombocytopenic purpure (ITP). Most of them were younger children with severe thrombocytopenia; 71.3% were under 5 years old and 49.4% had platelet counts below 1×10⁴/μl. Initial treatment consisted of high-dose intravenous immunoglobulin in 60 (69.0%), steroid in 10 (11.5%), and no therapy in 17 (19.5%). More than 90% of the children with platelet counts below 2×10⁴/μl received treatment, but most children with platelet counts above 2×10⁴/μl were observed without treatment. No patients had complications with CNS hemorrhage. Chronic ITP was noted in 17 patients (19.5%). Their mean age was 6 years 3 months compared with 2 years 8 months for the acute patients (p<0.01). But there were no significant differences in sex, platelet count, and initial treatment between chronic ITP and acute ITP. Six (35.3%) out of 17 children with chronic ITP subsequently achieved a spontaneous recovery. As of today, only 3 patients (3% of all patients, and 17.6% of patients with chronic ITP) have platelet counts below 5×10⁴/μl. The overall prognosis and quality of life were excollent. Helicobacter Pylori (H. pylori) infection was found in 7.1% of the chronic patients and 5.3% of the acute patients, but platelet counts of them returned to normal without H. pylori eradication thrapy. It seemed that H. pylodi infection played a minor role in pediatric ITP.

We demonstrated the clinical features and outcome of 87 children with idiopathic thrombocytopenic purpure (ITP). Most of them were younger children with severe thrombocytopenia; 71.3% were under 5 years old and 49.4% had platelet counts below 1×104/μl. Initial treatment consisted of high-dose intravenous immunoglobulin in 60 (69.0%), steroid in 10 (11.5%), and no therapy in 17 (19.5%). More than 90% of the children with platelet counts below 2×104/μl received treatment, but most children with platelet counts above 2×104/μl were observed without treatment. No patients had complications with CNS hemorrhage. Chronic ITP was noted in 17 patients (19.5%). Their mean age was 6 years 3 months compared with 2 years 8 months for the acute patients (p<0.01). But there were no significant differences in sex, platelet count, and initial treatment between chronic ITP and acute ITP. Six (35.3%) out of 17 children with chronic ITP subsequently achieved a spontaneous recovery. As of today, only 3 patients (3% of all patients, and 17.6% of patients with chronic ITP) have platelet counts below 5×104/μl. The overall prognosis and quality of life were excollent. Helicobacter Pylori (H. pylori) infection was found in 7.1% of the chronic patients and 5.3% of the acute patients, but platelet counts of them returned to normal without H. pylori eradication thrapy. It seemed that H. pylodi infection played a minor role in pediatric ITP.
Purpura, Thrombocytopenic, Idiopathic ; Child ; Platelet Count ; seconds ; Chronic

BACKGROUND/AIMS: There are few reports on the correlation between chewing gum and the gastrointestinal functions. But previous report showed use of chewing gum to be an effective method for controlling gastrointestinal symptoms. The aim of this study was to determine the correlation between chewing gum and gastric emptying using the continuous real time 13C breath test (BreathID system). METHODS: Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to chewing gum (Xylish, 2-3/1 tablet) for an hour following intake of a test meal (200 kcal/200 mL) or intake of the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal by the 13C-acetic acid breath test performed continually using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, T1/2 (median, 111.82 vs 109.26 minutes; P = 0.575), Tlag (median, 53.28 vs 56.53 minutes; P = 0.333), gastric emptying coefficient (median, 3.58 vs 3.65; P = 0.285), regression-estimated constant beta (median, 1.85 vs 1.80; P = 0.575) and regression-estimated constant kappa (median, 0.61 vs 0.62; P = 0.959) were observed between the test meal alone group and the test meal and chewing gum group. CONCLUSIONS: This study showed that chewing gum had no effect on the rate of gastric emptying. Therefore, since chewing gum did not enhance the speed of gastric emptying, it may ameliorate gastrointestinal symptoms through other mechanisms, such as saliva and autonomic nervous system.
Autonomic Nervous System ; Breath Tests ; Chewing Gum ; Cross-Over Studies ; Gastric Emptying ; Humans ; Male ; Mastication ; Meals ; Saliva

BACKGROUND/AIMS: The aim of this study was to examine the convenience of the quality of life and utility evaluation survey technology (QUEST) questionnaire and the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) questionnaire as self-assessment diagnostic instrument. METHODS: This was a two-way crossover study conducted over 6 weeks from September 2010 to November 2010. The subjects were 60 consecutive patients admitted to the Hiratsuka city hospital with a gastrointestinal condition, regardless of the coexistence of heartburn. They were assigned to fill in both the QUEST and FSSG questionnaires in random order. We analyzed the time taken to complete the questionnaires, whether subjects asked any questions as they filled in the questionnaire, and the questionnaire scores. RESULTS: Comparison of the QUEST and the FSSG revealed significant differences in the completion time (196.5 vs. 97.5 seconds, respectively; P < 0.0001) and in whether subjects asked any questions (37 vs. 15 subjects, respectively; P < 0.0001). Completion time in QUEST scores of > or = 4 was lower than < 4 (170.5 vs. 214.0 seconds, respectively; P = 0.022), and the QUEST score was significantly higher without questions than with question (3 vs. 1 points, respectively; P = 0.025). CONCLUSIONS: This study revealed that the FSSG questionnaire may be easier for Japanese subjects to complete than the QUEST questionnaire.
Asian Continental Ancestry Group ; Cross-Over Studies ; Gastroesophageal Reflux ; Heartburn ; Hospitals, Urban ; Humans ; Quality of Life ; Surveys and Questionnaires ; Self-Assessment

BACKGROUND/AIMS: The effects of Histamine-2 receptor antagonists and proton pump inhibitors on the gastrointestinal motility have not yet been sufficiently investigated. The aim of this study was to determine the effects of intravenous bolus administration of famotidine and omeprazole on the rate of gastric emptying using the continuous 13C breath test (BreathID system, Exalenz Bioscience Ltd, Israel). METHODS: Twelve healthy male volunteers participated in this randomized, 3-way crossover study. After fasting overnight, the subjects were randomly assigned to receive 20 mg of famotidine, 20 mg of omeprazole or 20 mL of saline alone by intravenous bolus injection before a test meal (200 kcal per 200 mL, containing 100 mg of 13C-acetate). Gastric emptying was monitored for 4 hours after the ingestion of test meal by the 13C-acetic acid breath test performed using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, the T1/2, Tlag, GEC, beta and kappa, were observed among the 3 test conditions. CONCLUSIONS: The study revealed that intravenous administration of gastric acid suppressant drugs had no significant influence on the rate of gastric emptying in comparison with that of saline alone as a placebo. Our results indicating the absence of any effect of either famotidine or omeprazole on accelerating the rate of gastric emptying suggest that both medications can be administered safely to patients suffering from hemorrhagic peptic ulcers who need to be kept nil by mouth from the viewpoint of possible acceleration of gastrointestinal motility in the clinical setting.
Acceleration ; Administration, Intravenous ; Breath Tests ; Cross-Over Studies ; Eating ; Famotidine ; Fasting ; Gastric Acid ; Gastric Emptying ; Gastrointestinal Motility ; Humans ; Male ; Meals ; Mouth ; Omeprazole ; Peptic Ulcer ; Proton Pump Inhibitors ; Proton Pumps ; Protons ; Stress, Psychological

BACKGROUND/AIMS: The administration of liquid nutrients to patients is often accompanied by complications such as gastroesophageal reflux. To prevent gastroesophageal reflux, high-viscosity liquid meals are used widely, however, it still remains controversial whether high-viscosity liquid meals have any effect on the rate of gastric emptying. The present study was conducted with the aim of determining whether high-viscosity liquid meals had any effect on the rate of gastric emptying and mosapride might accelerate the rate of gastric emptying of high-viscosity liquid meals. METHODS: Six healthy male volunteers underwent 3 tests at intervals of > 1 week. After fasting for > 8 hours, each subject received one of three test meals (liquid meal only, high-viscosity liquid meal [liquid meal plus pectin] only, or high-viscosity liquid meal 30 minutes after intake of mosapride). A 13C-acetic acid breath test was performed, which monitored the rate of gastric emptying for 4 hours. Using the Oridion Research Software (beta version), breath test parameters were calculated. The study parameters were examined for all the 3 test conditions and compared using the Freidman test. RESULTS: Gastric emptying was significantly delayed following intake of a high-viscosity liquid meal alone as compared with a liquid meal alone; however, intake of mosapride prior to a high-viscosity liquid meal was associated with a significantly accelerated rate of gastric emptying as compared with a high-viscosity liquid meal alone. CONCLUSIONS: This study showed that high-viscosity liquid meals delayed gastric emptying: however, mosapride recovered the delayed rate of gastric emptying by high-viscosity liquid meals.
Benzamides ; Breath Tests ; Cross-Over Studies ; Fasting ; Gastric Emptying ; Gastroesophageal Reflux ; Humans ; Male ; Meals ; Morpholines ; Pectins