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Biomedical subjects

D H Shmerling

Publications and source records attributed to D H Shmerling.

At least 55 records · Page 3Linked to original sources
PubMed1979

The diagnosis of coeliac disease. A commentary on the current practices of members of the European Society for Paediatric Gastroenterology and Nutrition (ESPGAN).

In 1977, 53 members of ESPGAN completed a questionnaire on their current practice in diagnosing coeliac disease. The usefulness of the 'Interlaken' criteria enumerated 9 years previously was reassessed. Details were obtained about the initial diagnostic approach, the acceptable histological criteria of the initial jejunal biopsy, and the timing, technique, response, and interpretation of early and late rechallenges with gluten. Answers indicated that, although the initial mucosal lesion is usually 'flat' at the time of diagnosis, a few infants may present at a time when the mucosal lesion is less completely damaged. Furthermore, the degree of histological change after gluten challenge that is acceptable as a positive response may vary according to the state of the mucosa before challenge. It was noted that there are still no generally agreed criteria by which the histological lesions may be described, so that (after further discussions at the Third International Coeliac Conference in Galway) a European panel has been set up to make recommendations. In the experience of ESPGAN members, most coeliac children will have a histological relapse within 2 years of reintroduction of gluten. But a small number of unorthodox cases were reported that suggest that (a) histological relapse may take longer than 2 years to appear, or (b) the degree of sensitivity to gluten may vary at different ages. Very long-term follow-up will be needed to explain these anomalies. Meanwhile the search continues for 'the basic defect'.

Age Factors↗
PubMed1979

[Effect of previous breast feeding and early diagnosis on the course of cow's milk protein intolerance].

The clinical course of 21 children with cow's milk protein intolerance (CMPI) who were treated at the Children's Hospital of Zurich during the years of 1963-1977 was analysed in retrospect. Oral cow's milk challenges undertaken 3 weeks after the beginning of the treatment or later did not lengthen the apparent duration of the disease. Children who had initially been breast fed during at least 10 days, and those who were treated within 2 weeks after the appearance of the first symptoms with a cow's milk-free diet presented a milder and shorter course of CMPI. Severely undernourished or dehydrated patients did not differ from others in the course or duration of the disease, and patients with bloody stools showed a less serious but not shorter course of the CMPI.

Animals↗
PubMed1978

PABA screening test for exocrine pancreatic function in infants and children.

P-Amino-benzoic acid (PABA) is split specifically by pancreatic chymotrypsin from the synthetic tripeptide N-benzoyl-L-tyrosyl-PABA. The urinary excretion of absorbed PABA serves as an index for exocrine pancreatic function. The peptide (0.015 g/kg) was administered orally to 20 controls (aged between 5 months and 16 years), 6 patients with exocrine pancreatic insufficiency caused by cystic fibrosis (CF), and 9 newborn infants. In the controls the mean 6-hour PABA recovery was 58.5% (+/- 11.2 SD). Recovery in patients with CF was lower (P less than 0.001) with no overlap. In newborn infants the mean 6-hour PABA recovery was 23.4 (+/- 17.7 SD); overlapping in 3 instances with the results in CF patients. This simple, noninvasive test thus appears promising and merits further investigation in younger infants, especially newborns.

4-Aminobenzoic Acid↗
PubMed1978

Growth retardation and bone mineral status in children with coeliac disease recognized after the age of 3 years.

Growth data, clinical symptoms and bone mineral parameters were analyzed in 20 children with coeliac disease in whom the diagnosis was established by biopsy at age 3-13 years. Small stature and bone age retardation (greater than 2 SD) were present in 65% and 60%, respectively. Typical clinical symptoms of coeliac disease as found in the younger child were present in many cases, but 3 were completely asymptomatic except for severe growth retardation. Metacarpal diameters and cortical thickness were significantly decreased for chronological age but in most cases normal for bone age. Quantitative bone mineral analysis of the radius by computed tomography revealed normal values for height and weight in the 4 cases investigated. It is concluded that coeliac disease should always be considered in the differential diagnosis of retarded growth and bone age. "Osteoporosis" may occur in coeliac disease, but does not necessarily accompany growth failure. The analysis of metacarpal diameters and cortical thickness in the search of "osteoporosis" may result in false interpretation if not correlated to height and weight.

Adolescent↗
PubMed1978

Granulomatous ileocolitis (Crohn's disease).

In a clinical survey, the symptoms, associated diseases, and local and metabolic complications of Crohn's disease are discussed. Medical treatment (with SASP, corticosteroids, and immunosuppressives), as well as treatment for malnutrition, is of special importance.

Adrenal Cortex Hormones↗
PubMed1978

Ulcerative colitis.

The clinical symptoms of ulcerative colitis are described and three main points are emphasized: 1. The importance of associated diseases of ulcerative colitis (hepatic involvement, arthropathy, skin affections, uveitis and thyroiditis). 2. The importance of psychopathological conflicts in the pathogenesis and treatment of the disease. 3. The necessity to have a well-balanced team of pediatricians, pediatric surgeons, psychologists or psychotherapists, pathologists, social workers and stoma therapists for optimal therapy.

Child↗
PubMed1977

Long-term results following extensive small intestinal resection in the neonatal period.

At Alder Hey Children's Hospital in Liverpool there have been 8 children who survived long-segment intestinal resection in the neonatal period for more than 10 years, and there has been one further case at the University Children's Hospital in Zürich. The total of 9 children who were left with residual lengths of small intestine of between 26 and 75 cm form the basis of this report. Seven of these children have been personally followed up. One patient, although apparently perfectly well, is now an adult, has left home and refused to be re-examined. One child has been followed up by another paediatrician. In general it can be said that, provided these children are treated with care postoperatively over a period which may extend for many months or even a few years, the ultimate prognosis is extremely good. These children will grow up perfectly normally and will have no absorption difficulties. If the child is left with less than 30 cm of small intestine, the initial treatment becomes very difficult, but with adequate management even these infants can finally grow up into perfectly normal children with little or no absorption difficulties. The critical length of intestine lies in the neighbourhood of 20 cm. Correct initial treatment is all important and the one case in this series where this was not carried out is the only child who has still considerable difficulties. In some of the children under discussion, a hemicolectomy was performed as well as the small intestinal resection. This does not seem to have made much difference to the ultimate satisfactory outcome.

Adolescent↗
PubMed1977

[Catamnestic study in 82 patients with unspecified changes in the small intestinal mucosa].

A definitive diagnosis could not be established in 135 out of 713 (19%) infants and children admitted for chronic diarrhea and/or failure to thrive during the first admission. Their mucosal biopsy findings were either normal or showed unspecific changes. A retrospective inquiry, 1 1/2 to 8 years later, into the later course of 82 out of the initial 135 children revealed that 76.5% were free of symptoms without any specific therapy within a short time after discharge. The remaining 19 cases still complained of similar symptoms as initially. In 6 of these patients the indication for further investigations was established. These patients presented already at the time of their first admission with the most severe mucosal alterations (convoluted pattern) and clinical symptoms. Although the majority of patients with mild and non-specific mucosal abnormalities proved to have had a self-limited harmless intestinal disease, in 7,3% of them further investigations during follow-up remain indicated.

Biopsy↗
PubMed1976

Development of digestive and absorptive function in the human fetus.

In the mature human newborn infant, only pancreatic alpha-amylase shows a very low but highly inducible activity. Other digestive enzymes, although not yet at adult levels, increase rapidly with age. Intestinal absorptive functions develop already during early and mid-pregnancy and are mostly at adult levels in the newborn infant. Fat absorption is usually low in the premature infant and increases rapidly during the first month.

Amylases↗
PubMed1975

Total parenteral alimentation in childhood general considerations.

The paper presents a discussion of the definition, the indications and some of the difficulties and complications of total long-term parenteral alimentation in infants and children. The problems of protein quality, the inadequacy of the E/T ratio, the quantities and quality of carbohydrates and the metabolic complications due to inappropriate electrolyte and mineral salts composition are reviewed. It is pointed out that the optimal amounts of some of the components used are still under investigation, that there seems to be no imperative reason not to use glucose as the sole carbohydrate in this age group and that most of the possible long-term sequelae and complications of total long-term parenteral alimentation will have to be looked for by prospective studies of the children treated.

Amino Acids↗