The ketogenic diet appears to be effective in reducing seizure frequency in patients with epilepsy refractory to antiepileptic drug therapy. Reported seizure frequencies before and after the diet was initiated were obtained for 48 patients started on the ketogenic diet between December 1994 and January 1998 at Children's Hospital of Pittsburgh. The majority of patients (71%) were able to achieve > or = 50% reduction in seizure activity. Of these, more than half (53%) had > 90% reduction in seizures after 45 days of diet therapy. Complications included gastrointestinal complaints and infrequent lipid abnormalities. The ketogenic diet appears to be an effective method of treatment for children with epilepsy refractory to drug therapy.
Fifty-five children received intestinal transplants (ITx) a t the Children's Hospital of Pittsburgh between July 1990 and January 1997. We assessed 23 children who had at least 1 year of follow-up with functioning intestinal grafts (7 isolated small bowel, 13 liver/ small bowel, and 3 multivisceral) for nutritional status, linear growth, and weight gain. We divided the children into 4 groups by age: infants <1 year (n = 41, toddlers 1-5 years (n = 61, preadolescents 5-10 years (n = 61, and adolescents 10-18 years (n = 7). We began an appropriate elemental formula at an average of 15 days post-ITx (median, 13 days). At l-year post-ITx, 15 children (65%) were thriving on oral diets, 7 children (31%) required enteral tube feedings that were secondary to oral aversion, and 1 child (4%) received partial parenteral nutrition support. Anthropometric data showed linear growth, appropriate weight in relation to height, and maintenance of fat and muscle stores. Serum albumin increased oneyear post-ITx in each age group. Serum zinc and red blood cell (RBC) folate levels were commonly found to be abnormal post-ITx.
PREINTESTINAL TRANSPLANT EVALUATIONWe referred all candidates for intestinal transplant (ITx) to the Intestinal Care Center (ICC) of the Children's Hospital of Pittsburgh with a diagnosis of intestinal failure. Intestinal failure in children can be classified into one of two categories: anatomic or functional.' Anatomic causes of intestinal failure occur because of a decreased length of bowel after resection that is secondary to diseases such as midCorrespondence and reprint requests: Sharon L. Strohm, hIBA,
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