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Biomedical subjects

J J Herbst

Publications and source records attributed to J J Herbst.

At least 19 recordsLinked to original sources
PubMed1979

Patterns of postcibal gastroesophageal reflux in symptomatic infants.

Symptomatic infants displayed three patterns of gastroesophageal reflux after drinking apple juice (20 ml/kg or 300 ml/m2 of body surface area). The type I pattern occurred in patients who had continuous postcibal gastroesophageal reflux, large hiatal hernias and frequently required an antireflux operation. A functional motility disorder suggesting delayed gastric emptying appeared to be important in infants with discontinuous reflux (type II pattern). These infants had frequent gastroesophageal reflux for only 2 3/4 hours postcibally, antral-pylorospasm, increased low esophageal sphincter pressures, and a high incidence of pulmonary symptoms and non-specific watery diarrhea. The mixed (type III) pattern of gastroesophageal reflux occurred in a small number of infants and exhibited features of both type I and II patterns.

Child, Preschool↗
PubMed1979

Gastroesophageal reflux causing respiratory distress and apnea in newborn infants.

Respiratory distress, apnea, and chronic pulmonary disease since birth were identified in 14 infants who also had symptomatic gastroesophageal reflux. Birth weights varied from 760 to 4,540 gm. All infants had radiographic changes similar to those in bronchopulmonary dysplasia. Cessation of apnea and improvement of pulmonary disease occurred only after medical (8) or surgical (6) control of gastroesophageal reflux. Simultaneous tracings of esophageal pH, heart rate, impedance pneumography, and nasal air flow in five infants demonstrated that reflux preceded apnea. Apnea could be induced by instillation of dilute acid, but not water or formula, into the esophagus. Prolonged monitoring of esophageal pH more than two hours after feeding in 14 other infants less than 6 weeks of age (birth weight 780 to 3,350 gm) without a history of recent vomiting indicated that reflux was not greater than in normal older children.

Apnea↗
PubMed1979

The lower esophageal sphincter in gastroesophageal reflux in children.

Esophageal function was evaluated in 51 children less than 2 years of age with radiologic evidence of gastroesophageal reflux. Detection of an acid esophageal pH was a sensitive measure of gastroesophageal reflux. Lower esophageal sphincter pressures were greater in reflux patients with respiratory symptoms (18.0 +/- 1.4 mm Hg) than in reflux patients without respiratory symptoms (9.5 +/- 1.0 mm Hg). The intra-abdominal segment of the lower esophageal sphincter was shorter in patients with reflux than in controls (0.51 +/- 0.05 cm vs. 0.75 +/- 0.08 cm). It was also shorter in patients requiring surgical therapy (0.34 +/- 0.05 cm) than in those responding to medical therapy (0.63 +/- 0.07 cm).

Age Factors↗
PubMed1978

Hazards of calcium gluconate therapy in the newborn infant: intra-arterial injection producing intestinal necrosis in rabbit ileum.

Five infants received 10% calcium gluconate via umbilical artery catheters, which resulted in intestinal bleeding and lesions of the buttock, anus, groin, and thigh. The effects of intra-arterial calcium gluconate in two animal models were investigated. Injection of calcium into the aorta in the region of the posterior mesenteric artery resulted in immediate hyperperfusion of the descending colon; this may be an early hemodynamic response to injury in the area of colon supplied by this vessel. Injections into the arterial arcade of the rabbit ileum resulted in intestinal necrosis and villous atrophy. The use of umbilical artery catheters for administration of calcium gluconate is potentially hazardous.

Animals↗
PubMed1978

Cell proliferation in esophageal columnar epithelium (Barrett's esophagus).

In order to correlate histopathology and cell turnover in esophageal tissue in patients with esophageal columnar epithelium, biopsy specimens from 11 patients were studied. Two of the patients had adenocarcinoma of the esophagus not present in the specimens studied. In the heterogeneous esophageal columnar epithelium, the DNA synthesis phase averaged 10.4 +/- 0.3 hr; labeling index of cells in the crypt-like structures was 23.3 +/- 0.3%; generation time was 44.6 +/- 1.2 hr, and the mitotic index was 1.82 +/- 0.07%. Significant differences were not present among specimens with columnar epithelium but they differed from cell proliferation in adjacent squamous epithelium where S phase was similar but labeling and mitotic indexes were lower and generation time increased to 105 +/- 6 hr. In the 2 patients with adenocarcinoma of the esophagus, and in 1 of 9 without adenocarcinoma, labeling of surface columnar cells after brief exposure to [3H]thymidine was present suggests that this may be a manifestation of early malignant change.

Adenocarcinoma↗
PubMed1977

Childhood gastroesophageal reflux. Neurologic and psychiatric syndromes mimicked.

Thirteen infants and children with proved gastroesophageal (GE) reflux had complaints that suggested a CNS disorder. Symptoms began in early infancy in ten cases, but accurate diagnosis and proper treatment were not instituted in three cases until three to five years of age. A CNS basis for their disease was suspected because they exhibited specific signs or because the importance of associated gastrointestinal (GL) and respiratory tract symptoms was not appreciated. The presenting CNS symptoms and signs included dystonia in 11, developmental retardation in ten, dysphagia in nine, seizures in six, and extreme irritability in ten. We believe that the diagnosis of symptom-causing GE reflux is being missed regularly. The effects of proper medical or surgical therapy are often dramatic, and the consequences of missed diagnosis or improper treatment are potentially lethal.

Age Factors↗
PubMed1977

Defective neutrophil chemotactic responses in patients with recurrent episodes of otitis media and chronic diarrhea.

Fourteen patients who had repeated episodes of otitis media and diarrhea were evaluated to determine if a defect in the host defense mechanism could account for the unusual incidence of infection. Each of the patients with recurrent otitis media and diarrhea had a profound defect in neutrophil chemotactic responsiveness. The mean chemotactic index of the patients was 21 +/- 6, while that of 25 controls was 62 + 10. Other neutrophil functions, lymphocyte T-cell populations, immunoglobulins, and complement components were normal in the patients. Serum IgE levels were also normal. The presence of a defect in neutrophil chemotaxis in these patients with recurrent otitis media and chronic diarrhea suggests that the phagocyte may play an important role in protection of the mucosal surfaces of the respiratory and gastrointestinal tracts.

Adolescent↗
PubMed1977

Evaluation of gastroesophageal reflux surgery in children.

Fifty-five infants and children with complications of gastroesophageal reflux required operative management for control of symptoms. All patients, except those with severe esophageal stricture, received a six-week trial with 60-degree constant elevation before an operation was considered necessary. The operation was performed to control (1) persistent vomiting, (2) vomiting with growth retardation, (3) esophagitis, (4) esophagitis with stricture, and (5) recurrent aspiration pneumonia. Preoperative and postoperative evaluation involved both X-ray fluoroscopy and esophageal manometry with pH studies. A good surgical result was not dependent upon an increase in the lower esophageal pressure following operation. The Boerema anterior gastropexy is simple and effective for controlling gastroesophageal reflux for cases uncomplicated by esophagitis, stricture, or previous operation. Complex cases with inflammatory or operative changes in the lower esophagus are more effectively treated by Nissen fundoplication.

Child, Preschool↗
PubMed1976

Gastroesophageal reflux with protein-losing enteropathy and finger clubbing.

Finger clubbing, protein-losing enteropathy, and iron deficiency were documented in three children with severe gastroesophageal reflux. One patient had Sandifer syndrome and the other two had the rumination syndrome. In each case, surgical repair of the gastroesophageal reflux resulted in immediate clearing of signs of the Sandifer syndrome, gastroesophageal reflux, and anemia and the return of serum protein levels to normal. There was definite regression of the finger clubbing during the ensuing year. It is suggested that finger clubbing, protein-losing enteropathy, Sandifer syndrome, and rumination be viewed as parts of an extended syndrome of unusual presentations of gastroesophageal reflux.

Anemia, Hypochromic↗
PubMed1976

Behavioral characteristics of children with chronic nonspecific diarrhea.

The authors obtained early case histories of 16 children with chronic nonspecific diarrhea and 16 control subjects and found that the index subjects had a significantly higher frequency of sleep problems, crying and irritability, digestive problems excluding diarrhea, overactivity, resistance to discipline, and family history of gastrointestinal problems. They conclude that these behavioral characteristics represent temperamental traits based on physiological factors, perhaps an imbalance of autonomic nervous system function. They speculate that chronic nonspecific diarrhea may occur in association with certain temperamental traits because both the somatic and psychic components stem from a common disturbance in autonomic nervous system function.

Child Behavior Disorders↗
PubMed1976

Elevated plasma levels of carcinoembryonic antigen in cystic fibrosis.

Elevated levels of plasma CEA were found in patients with cystic fibrosis. The elevations were well correlated with the Shwachman scores of the patients. Parallel changes of the levels of plasma CEA and clinical conditions of four patients were also observed in the follow-up studies. Close clinical examination indicated that the elevated plasma CEA of cystic fibrosis patients may be derived from sputum which is produced in abnormal amounts. This hypothesis is further supported by the very high content and the chromatographic profile of the CEA activity of sputum from patients with cystic fibrosis.

Carcinoembryonic Antigen↗
PubMed1976

Carbohydrate malabsorption in necrotizing enterocolitis.

A prospective investigation was conducted to determine if infants with necrotizing enterocolitis had evidence of carbohydrate intolerance prior to the onset of clinical symptoms of advanced disease. Stool specimens were examined for fecal reducing substances with Clintest tablets from well, full-term infants and sick premature infants. Only two of 45 (4.4%) formula-fed, full-term infants demonstrated higher than 2+ fecal reducing substances. Ten of 14 (71%) formula-fed premature infants who developed necrotizing enterocolitis had higher than 2+ reducing substances detected in their stools. Daily measurement of fecal reducing substances can be a useful adjunct in the management of sick premature infants.

Carbohydrate Metabolism↗