2 results
9.1 - Liver and intestinal transplantation
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- By Manuel Garcia-Careaga, M.D. Department of Pediatrics, Division of Gastroenterology, Lucile Packard Children's Hospital, Palo Alto, California 94304, USA, Ricardo Orlando Castillo, M.D. Department of Pediatrics, Division of Gastroenterology, Lucile Packard Children's Hospital, Palo Alto, California 94304, USA, John A. Kerner Jr., M.D. Department of Pediatrics, Division of Gastroenterology, Lucile Packard Children's Hospital, Palo Alto, California 94304, USA
- Edited by Lorry R. Frankel, Stanford University, California, Amnon Goldworth, Stanford University, California, Mary V. Rorty, Stanford University, California, William A. Silverman, Columbia University, New York
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- Book:
- Ethical Dilemmas in Pediatrics
- Published online:
- 18 August 2009
- Print publication:
- 10 June 2005, pp 190-195
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Summary
Introduction
In 1959, Richard Lillehei et al. were the first to describe the autologous intestinal transplantation of the entire small intestine in dogs (Lillehei et al. 1959). The transplanted bowel had an indefinite survival. One year later Starzl and Kaupp successfully transplanted multiple viscera including small bowel in dogs. The surgical techniques originally described by Starzl are employed to this day (Kocoshis 1994).
In the 1960s and 1970s, several reports of human multi-organ transplantation and intestinal transplants were published, but the immunosuppressants used at that time, consisting of prednisone and azathioprine, did not confer sufficient protection against rejection (Grant 1989). The patients did not survive longer than a few weeks. These results were so devastating that intestinal transplantation was discontinued. It was not until the discovery of cyclosporin that attempts at intestinal transplantation were resumed. The introduction of OKT3 and the use of irradiation of the graft yielded encouraging results. In a small series of four intestinal-transplant patients, two of them survived 109 and 165 days. Both of them died as a result of developing lymphoproliferative disorder but not as a result of rejection. With the appearance of newer immunosuppressants like FK506, survival significantly improved, resulting in increased implementation of this potentially life-saving procedure.
From 1990 to 1994, the group at the Children's Hospital at Pittsburgh operated on more than 50 patients of which 32 were children, ranging in age from 6 months to 15 years (Kocoshis 1994). Twenty patients had combined liver and intestinal transplants.
3.1 - Munchausen syndrome by proxy
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- By Manuel Garcia-Careaga, M.D. Department of Pediatrics, Division of Gastroenterology, Lucile Packard Children's Hospital, Palo Alto, California 94304, USA, John A. Kerner Jr., M.D. Department of Pediatrics, Division of Gastroenterology, Lucile Packard Children's Hospital, Palo Alto, California 94304, USA
- Edited by Lorry R. Frankel, Stanford University, California, Amnon Goldworth, Stanford University, California, Mary V. Rorty, Stanford University, California, William A. Silverman, Columbia University, New York
-
- Book:
- Ethical Dilemmas in Pediatrics
- Published online:
- 18 August 2009
- Print publication:
- 10 June 2005, pp 55-66
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- Chapter
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Summary
Introduction
Munchausen syndrome by proxy (MSBP), first described by Professor Roy Meadow in 1977, is a form of child abuse where there is persistent fabrication of symptoms of illness on behalf of an unsuspecting or helpless victim that causes the victim to be regarded as ill by others (Meadow 1977). Methods of fabrication include: (1) fictitious history (false reporting of symptoms), (2) simulation, (3) induction, (4) withholding medications in a chronically ill child (e.g., in a child with asthma). The perpetrator may use more than one of the above methods. Criteria have been established (Table 3.1). MSBP can occur in individuals with a “true physical disorder” in which case the symptoms are exaggerated to the point that the child is subjected to multiple unnecessary treatments and/or investigations (Rosenberg 1987).
In a survey of all pediatricians in England and Ireland, the two-year combined annual incidence of MSBP was at least 0.5 per 100 000 children and at least 2.8 per 100 000 for children under one year of age (McClure et al. 1996). As of 1997, there were close to 300 articles published on MSBP in professional journals worldwide, with authors representing disciplines such as medicine, law, nursing, psychology, psychiatry, and social work. In more than 300 cases described by Meadow (1977), the perpetrator was the child's biological mother in ∼90% of the cases (another female caregiver, baby-sitter, or nurse in ∼5%, and the child's father in ∼5%).