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Biomedical subjects

B S Reid

Publications and source records attributed to B S Reid.

At least 19 recordsLinked to original sources
PubMed1998

Are scintiscans accurate in the selection of reflux patients for pyloroplasty?

BACKGROUND: Gastric emptying scintiscans are currently used to select reflux patients for added pyloroplasty at the time of fundoplication. The accuracy of this scan selection approach has been assumed. If preoperative scintiscans do not reliably predict postfundoplication gastric emptying, however, the decision to add pyloroplasty to the fundoplication operation may be inappropriate and even harmful. METHODS: The authors studied 27 children prospectively before and after gastric fundoplication. Gastric emptying at 60 minutes was measured by double isotopic labeling of liquid (111In) and solid (99mTc) phases of a test meal specifically designed for label fixation. The authors' question involved the accuracy of preoperative gastric scintiscans in predicting postfundoplication delay of gastric emptying (DGE). An evaluation of pyloroplasty as an effective treatment for DGE was not part of the study design. Pyloroplasty was performed as a secondary operation in three of the study children, however, because they persisted with unrelieved symptoms of retching, fullness, and abdominal discomfort. Scintiscan-documented postfundoplication delay in gastric emptying was present in all three patients at 18, 58, and 12 weeks, respectively. Additional scintiscans were performed in these patients after pyloroplasty. RESULTS: Gastric emptying of solids at 60 minutes did not show a significant change after a gastric fundoplication operation, although the trend was in the direction of a decrease (paired t test, P= .13). Liquid emptying at 60 minutes, however, was significantly increased (paired t test, P = .01). The variation in values between patients was wide, and the correlation between pre- and postoperative study results in the same patient was poor (r2 = 0.337 for solids and r2 = 0.116 for liquids). Most unexpectedly, scintiscans after postfundoplication pyloroplasty in the three patients with persistent symptoms showed no improvement in delayed gastric emptying on repeat scintiscan 42 to 117 weeks later. CONCLUSIONS: The data suggest that preoperative scintiscan evidence for postfundoplication DGE is probably accurate for solid emptying but not for liquids, at least as measured by the double isotope methodology of our study. Preoperative scintiscans that use a liquid phase label only may be highly misleading for the prediction of postfundoplication DGE. Furthermore, pyloroplasty may not be useful as treatment even when postfundoplication delay in gastric emptying can be accurately anticipated or confirmed. A fundamental motility disorder of the gastric body seems to be more important than muscular resistance at the gastric outlet as a cause for postfundoplication DGE, and the most effective treatment approach remains unclear.

Adolescent↗
PubMed1998

Congenital varicella-zoster virus infection and Barrett's esophagus.

Congenital varicella syndrome is a rare complication of varicella-zoster virus (VZV) infection during pregnancy. An infant was exposed to VZV at 18.5 weeks of gestation and had eye and skin abnormalities at birth and persistent feeding difficulties, prompting esophageal biopsies at 12 days and 20 and 20.5 months of age. Esophageal tissues demonstrated specialized intestinal metaplasia (Barrett's esophagus). VZV DNA (in situ hybridization) and proteins (immunohistochemistry and polymerase chain reaction) were found in esophageal epithelial cells adjacent to the Barrett's lesion. Immediate-early 63 protein (IE63) of VZV was demonstrated in the day 12 specimen, and IE62 and the late VZV glycoprotein E (gE) were found in the 20-month specimen. Clinical and endoscopic improvement followed fundoplication and acyclovir therapy, but VZV DNA and IE62 persisted in esophageal tissue. These findings associate VZV with specialized intestinal metaplasia within the esophagus and suggest a novel site for either latent or active VZV infection.

Barrett Esophagus↗
PubMed1998

Immunosuppressive therapy with microemulsion cyclosporine A shortens the hospitalization of pediatric liver transplant recipients.

Intravenous administration of cyclosporine (Sandimmune) to rapidly and effectively achieve therapeutic serum levels in transplant recipients has been the treatment standard in many transplantation centers. With the development of microemulsion cyclosporine (Neoral), that standard is changing. Neoral has greater bioavailability than the oral form of Sandimmune and, consequently, can be more efficacious and cost-effective. To test this hypothesis, we undertook a retrospective study of Sandimmune and Neoral in the treatment of 66 children who underwent uncomplicated orthotopic liver transplantation in the Texas Medical Center between April 1991 and December 1997. Both forms of cyclosporine were evaluated in terms of in-patient treatment cost, recuperative time in the intensive care unit and duration of hospitalization. Twenty-two patients were treated orally with Neoral, and 44 patients were treated intravenously with Sandimmune for a mean time of 14 d. Once the blood concentration of Sandimmune reached a steady state, as confirmed by daily measurements of the trough level, the patients in the Sandimmune group were converted to oral cyclosporine. None of the 22 patients treated with Neoral required intravenous treatment. The mean time spent in the intensive care unit was 4 d for the Neoral group and 5.5 d for the Sandimmune group. The mean duration of hospitalization from the date of transplantation to discharge was 12 d for the Neoral group and 20 d for the Sandimmune group (p < 0.001). Based on these results, we determined that the overall cost per patient in the Neoral group was $3598 less than that per patient in the Sandimmune group.

Adolescent↗
PubMed1995

Color Doppler ultrasound in newborn testis torsion.

OBJECTIVES: To assess the usefulness of color Doppler ultrasound in evaluating the newborn with suspected antenatal testis torsion. METHODS: Nine newborns with 10 antenatally torsed testes were examined using color Doppler and gray-scale ultrasound. RESULTS: Each examination revealed lack of intratesticular blood flow on the affected side and normal flow within the contralateral testis. In addition, gray-scale sonographic architecture of the affected testes appeared to reflect the duration of in utero torsion. CONCLUSIONS: Color Doppler sonography accurately assesses intratesticular blood flow in newborns with antenatal testis torsion and offers interesting details.

Humans↗
PubMed1992

Cholelithiasis in infants receiving furosemide: a prospective study of the incidence and one-year follow-up.

Cholelithiasis has been reported to occur rarely in infants. To determine the incidence of cholelithiasis in infants receiving furosemide, we prospectively performed ultrasonograms on 86 patients. We studied 42 patients receiving furosemide (subjects) and 44 patients not receiving furosemide (controls). There was a significantly higher incidence of gallstones in subjects (21%) than in controls (2%) (P less than .05). When followed over 1 year, the gallstones did not resolve. There were no significant differences in the dosage of furosemide, gestational age, placement of umbilical venous catheters, or amount of total parenteral nutrition (TPN) between subjects with and without gallstones. However, subjects received more days of TPN (16.7 +/- 15.1) than controls (8.4 +/- 13.2) (P less than .05). These data show that the incidence of cholelithiasis is higher than previously suspected in infants receiving furosemide. Thus, furosemide, either independently or in conjunction with the use of TPN, predisposes infants to the development of cholelithiasis.

Bronchopulmonary Dysplasia↗
PubMed1988

Hemoperitoneum from perforated Meckel's diverticulum.

Approximately 4% of patients with Meckel's diverticulum will experience complication, the most common of which are intestinal obstruction, gastrointestinal bleeding, acute inflammation, and perforation. We report an extremely rare complication of perforated Meckel's diverticulum which presented as hemoperitoneum.

Child↗
PubMed1988

Radiographic evaluation of children with urinary tract infections.

Any child with urinary tract infection needs a radiologic work-up to determine his or her potential risk for sustaining renal damage. VCUG, either fluoroscopic or isotopic, should always be performed. If the infection responds to treatment and the VCUG is normal, ultrasonography should be performed. However, when the VCUG demonstrates reflux, radionuclide scan or, less preferably, excretory urography is indicated to assess renal parenchymal damage and function. When a urinary tract infection does not respond to treatment, ultrasonography or CT scan should be obtained to check for renal or perirenal abscess. If the findings are normal, medical treatment to control the infection is indicated. Further evaluation of the urinary tract may be temporarily delayed. In an infant with urinary tract infection and sepsis, renal ultrasonography is indicated. If the sonogram is normal, VCUG can be delayed until the infant responds to medical treatment. If ultrasonography is abnormal, VCUG and radionuclide scan such as 99mtechnetium DTPA with furosemide to evaluate gross morphology and function should be obtained. Complicated medical problems, such as urinary tract infection in combination with a history of intravenous drug abuse or with findings of fever and a mass, deserve immediate evaluation with ultrasonography or CT scan. A patient with fever of unknown origin and normal urine culture should have a radionuclide scan using gallium67 citrate or indium111-tagged leukocytes, both of which can demonstrate an extrarenal or unsuspected intrarenal site of infection. A variety of imaging modalities are available today for investigating urinary tract infections in the pediatric patient. Used intelligently, singly or in combination, these examinations provide information for the clinical evaluation as well as short-and long-term management of infections, their causes and complication, and their effect on renal function.

Child, Preschool↗
PubMed1987

Emergency gastrotomy: treatment of choice for iron bezoar.

The authors believe that gastrotomy and surgical removal of tablets is the treatment of choice in massive iron ingestion with development of an "iron bezoar" unresponsive to gastric lavage. Prompt surgical treatment in such cases may be lifesaving.

Acute Disease↗
PubMed1986

Autonomous ovarian hyperfunction followed by gonadotrophin-dependent puberty in McCune-Albright syndrome.

A 5-year-old girl with the McCune-Albright syndrome presented with precocious puberty secondary to autonomously functioning ovarian cysts, followed by true central puberty. Progression from gonadotrophin-independent to gonadotrophin-dependent precocious puberty may occur from elevated sex steroid levels leading to the early maturation of the hypothalamic-pituitary axis.

Child, Preschool↗
PubMed1985

Nephrolithiasis in premature infants.

The clinical records of ten premature infants with nephrolithiasis were reviewed. The probable mechanism of stone formation was hypercalciuria due to furosemide therapy (nine patients) and congenital hyperparathyroidism (one patient). The relatively high rates of urinary excretion of calcium from immature kidneys predisposed these neonates to the development of calcium stones. Renal calculi in neonates are complications of distinct, treatable conditions, and premature babies receiving furosemide treatment should be screened by ultrasonography for renal calcifications.

Female↗
PubMed1984

Preoperative ultrasound and gallium-67 evaluation of abdominal non-Hodgkin's lymphoma.

The diagnostic accuracy of abdominal ultrasonography followed by gallium (Ga)-67 scintigraphy in 21 patients, aged 1 to 14 years, appearing with abdominal non-Hodgkin's lymphoma (NHL) was analyzed. All cases were confirmed by biopsy; in a majority (16 patients), the tissue was obtained from an abdominal mass at the time of laparotomy subsequent to the imaging studies. Nineteen satisfactory abdominal ultrasound examinations were performed; 18 were interpreted as characteristic of NHL. Sixteen of these were of masses involving the gastrointestinal tract. All 21 patients had 67Ga scintigraphy that demonstrated abnormal radionuclide accumulation in the abdomen. In no instance was the final diagnosis different from the one predicted by the combined imaging studies. Ultrasonography is recommended as the initial test in the evaluation of clinical presentations consistent with abdominal NHL to expedite suitable management and prevent inappropriate surgery.

Abdominal Neoplasms↗
PubMed1984

Water-path ultrasound of chest disease in childhood.

While contact ultrasound has been used to assess the pleural space, pulmonary parenchyma, and mediastinum, there have been many difficulties owing to attenuation by bone and air interfaces. The authors have obtained excellent results using water-path ultrasound in 82 children with benign and malignant thoracic disease. The physical characteristics of the water path and the ability to scan dependent portions of the chest in various planes facilitated identification and characterization of lesions involving the chest wall, pleura, parenchyma, and mediastinum.

Adolescent↗
PubMed1984

Percutaneous drainage of abdominal fluid collections in children.

Percutaneous drainage of intraabdominal fluid collections was performed in 13 children. After initial diagnosis with either sonography or computed tomography, a smallbore aspiration needle (22 gauge) was guided into the collection, usually by sonography. In five patients, complete evacuation was possible using the aspirating needle alone. In seven others, the fluid was successfully drained via a catheter introduced percutaneously. In one patient, surgery was required for complete evacuation of a hematoma containing large blood clots. There were no complications.

Adolescent↗