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Biomedical subjects

J L Sutphen

Publications and source records attributed to J L Sutphen.

At least 19 recordsLinked to original sources
PubMed1992

Medium chain triglyceride in the therapy of gastroesophageal reflux.

Carbohydrate solutions that empty rapidly from the stomach have been shown to produce less gastroesophageal reflux (GER) during the postcibal period than more slowly emptying formulas. These observations have not been extended to complete infant formulas containing fat, carbohydrate, and protein constituents. Medium chain triglyceride has been shown to significantly accelerate gastric emptying compared to long chain triglyceride for preterm infants when investigated in commercial infant formulas. Using a previously reported acidified formula model coupled with esophageal pH probe testing, we have documented in a group of 28 infants that modification of formula by enrichment with medium chain triglyceride produced no improvement in rates of GER during the first 2 h after feeding.

Gastroesophageal Reflux↗
PubMed1991

pH-adjusted formula and gastroesophageal reflux.

To facilitate the detection of postcibal gastroesophageal reflux (GER), we have constructed an infant formula from modular carbohydrate, fat, and protein components with a pH of 4 and a nutrient composition identical to standard infant formula. In comparison to standard infant formula and sugar solutions, this pH-adjusted formula demonstrates a significantly greater amount of gastroesophageal reflex during the first postcibal hour. We speculate that the greater caloric density and slower gastric emptying of regular infant formula promotes greater gastroesophageal reflux than is observed with regular dextrose feedings. This effect is obscured unless the pH of the formula is adjusted. Use of this weakly acid formula in conjunction with postcibal esophageal pH probe recording facilitates the detection and, during simultaneous apnea monitoring, potential association of symptoms with postcibal gastroesophageal reflux.

Gastroesophageal Reflux↗
PubMed1991

Dietary treatment of lactose intolerance in infants and children.

During the past several years there have been many reports of alternative dietary therapies for primary and secondary lactose intolerance. We have learned that it is useful to feed through most episodes of mild diarrhea that previously would have been treated with clear liquid diets. Infant formulas, including both soy-protein and hydrolysate formulas with specially designed carbohydrate, protein, and fat components, are available to treat the infant with diarrheal syndromes and secondary lactase deficiency. Also, the diet can be supplemented with lactase. Specialized lactose-reduced products as well as cultured and fermented dairy products may be used in varying degrees for lactose-intolerant children. The ingestion of milk with food and fiber components in the diet has also been shown to improve symptoms of lactose intolerance. This review summarizes the essentials of diagnosis of and dietary therapy for lactose intolerance. Our findings indicate that a number of specialized formulas and products are available for successful dietary management of lactose intolerance in infants and children.

Child↗
PubMed1990

Hepatobiliary cystadenoma: a rare hepatic tumor in a child.

This report describes a 3-year-old child with a hepatobiliary cystadenoma. Cystadenomas are benign, multilocular, cystic neoplasms that usually occur in middle-aged women. The patients may be asymptomatic, but often there are vague abdominal complaints related to extrinsic compression of the stomach, duodenum, or biliary tree. Recurrence following incomplete excision and the presence of carcinoma within otherwise benign cysts has been documented. Complete resection is the therapy of choice, and thorough histopathologic evaluation is imperative.

Child, Preschool↗
PubMed1990

Pediatric gastroesophageal reflux disease.

Gastroesophageal reflux is a recognized clinical problem in infancy. To a great extent it represents a normal behavior that improves with maturation. The identification of appropriate candidates for medical and surgical therapy of GER during infancy is difficult and deserves further study. There are few well-conducted clinical trials of therapy for infantile GER that compare the usual drugs used for adults with GER. Moreover, medications currently licensed for adults are often not approved for pediatric use in the United States. Surgical therapy for GER should be reserved for infants with severe disease that does not respond to medical therapy.

Breast Feeding↗
PubMed1989

Dietary caloric density and osmolality influence gastroesophageal reflux in infants.

In a group of 19 infants being evaluated for gastro-esophageal reflux, we investigated the effects of various carbohydrate solutions (glucose polymers, 5% dextrose in water, and 10% dextrose in water) on the rate of postcibal gastroesophageal reflux during the first 2 h after a test feeding. The high-osmolality feeding (10% dextrose in water) produced significantly more postcibal gastroesophageal reflux over the entire 2-h interval. The major difference occurred in the second postcibal hour when the amount of gastroesophageal reflux was persistently high for 10% dextrose in water in contrast to the other feedings. We speculate that more rapid gastric emptying of low-osmolality solutions may account for these differences. Clear liquid feeding composition should be standardized during pH testing. Low-osmolality glucose polymer solutions may be more easily tolerated by infants with gastro-esophageal reflux who require carbohydrate or fluid supplements.

Dietary Carbohydrates↗
PubMed1989

Characterization of sulfasalazine's interference in the measurement of conjugated bilirubin by the Ektachem slide method.

We describe the cases of four patients who were taking sulfasalazine for inflammatory bowel disease, whose conjugated bilirubin concentrations in serum exceeded their corresponding total bilirubin concentrations as measured with a multilayer film analyzer, the Ektachem 400. Sulfasalazine added to pooled human serum at therapeutic concentrations increased the apparent conjugated bilirubin, as measured with the Ektachem, in a linear and dose-related fashion. Measured unconjugated bilirubin was simultaneously decreased to values less than -3 mg/L. The same interference occurred on the Ektachem 700, but an algorithm prevented the instrument from reporting the results. The major metabolites of sulfasalazine in blood did not interfere with analysis for those fractions of bilirubin. Sulfasalazine's strong absorbance at 400 nm explains its interference with determination of conjugated bilirubin in this instrument.

Bilirubin↗
PubMed1988

Intentional ipecac poisoning: Munchausen syndrome by proxy.

The intentional poisoning of two children with ipecac by their mothers is described. Intractable vomiting and diarrhea were the initial symptoms in both patients. In addition, one patient had clinical and laboratory evidence of skeletal and cardiac myopathy. Both children were subjected to extensive and invasive diagnostic evaluations before the correct diagnosis of chronic ipecac poisoning was made. These cases illustrate the toxic effects of ipecac ingestion and serve to alert physicians to child abuse by ipecac poisoning.

Child↗
PubMed1986

Effects of maturation and gastric acidity on gastroesophageal reflux in infants.

Using prolonged esophageal pH monitoring, we examined 42 infants referred for gastroesophageal reflux (GER) over a 16-month interval. Eighteen of these infants were also examined with intragastric pH monitoring following a standard formula meal. We found that prematurity and postcibal gastric acidity were significantly correlated with the amount of GER observed. Historical symptoms appeared to have little correlation with the amount of GER as measured by prolonged intraesophageal pH monitoring.

Age Factors↗
PubMed1986

Antacid and formula effects on gastric acidity in infants with gastroesophageal reflux.

A variety of peptic diseases are treated with antacids. Antacid dose requirements for young children have not been extensively evaluated. Moreover, the effects of formula feedings on antacid requirements are also unknown. We have investigated the effects of antacids and formula feedings on gastric acidity in infants less than 1 year of age. Small formula feedings of 15 mL/kg per feeding significantly improve antacid buffering of 0.5 mL/kg per dose of standard magnesium-aluminum hydroxide antacids.

Aluminum Hydroxide↗
PubMed1985

Growth as a measure of nutritional status.

Growth data have been used as a measure of nutritional status and disease activity in children. This review discusses common anthropometric techniques and emphasizes the inference of nutritional status from these measurements. As multiple factors influence growth, it is often difficult to isolate the effects of nutrition alone.

Adolescent↗
PubMed1985

Desquamative interstitial pneumonitis complicating inflammatory bowel disease of childhood.

Sulfasalazine has been associated with bronchopulmonary complications of inflammatory bowel disease (IBD) in adults. We describe a 12-year-old boy who developed desquamative interstitial pneumonitis and hepatic cirrhosis several years following the onset of ulcerative colitis. The restrictive lung disease progressed despite cessation of sulfasalazine and initiation of corticosteroid therapy. We discuss a variety of bronchopulmonary complications of IBD and their association with sulfasalazine.

Adolescent↗
PubMed1984

Metastatic cutaneous Crohn's disease.

A 16-yr-old boy and a 38-yr-old woman with Crohn's disease developed granulomatous dermatitis on the forearm and lower calf, respectively. Their lesions were clinically and histologically similar to those described in the small number of prior reports of "metastatic" cutaneous Crohn's disease. They were readily distinguished from those of other dermatologic conditions associated with Crohn's disease, such as pyoderma gangrenosum, erythema nodosum, and cutaneous polyarteritis nodosa. Appropriate clinical studies, biopsy specimens, and cultures are required, however, to exclude other forms of granulomatous disease that could occur coincidentally in a patient with Crohn's disease.

Adolescent↗
PubMed1983

Chronic diarrhea associated with Clostridium difficile in children.

Clostridium difficile toxin was associated with chronic diarrhea without classic symptoms of colitis in seven children (age range, 7 weeks to 7 years). All patients had received antibiotics. Six of the seven were treated with vancomycin hydrochloride and demonstrated improvement. After treatment, four patients suffered relapses, and three required further therapy. One patient had four relapses. During all clinical relapses, toxin reappeared in the stool; recovery was always associated with its disappearance. Fifty-six percent of family contacts examined had positive cultures. These findings document C difficile as a probable cause of chronic diarrhea in childhood and emphasize its infectious potential.

Bacterial Toxins↗
PubMedDate not supplied

The immature intestine: implications for nutrition of the neonate.

The survival and prognosis of the prematurely born human infant are dependent on a successful transition from the intrauterine to the extrauterine environment. This is largely a consequence of the maturation of sufficient gastrointestinal function to provide adequate nutrition. However, the gastrointestinal tract of the premature infant, and to some extent, of the full-term infant, may be unprepared to provide the requisite absorptive function. Data presented in this symposium emphasize the dissociations in the development of human gastrointestinal function. Morphological maturation is completed early in gestation while glucose absorption increases with gestational age. Sucrase and maltase activities appear early; lactase activity begins to increase at 30 weeks and increases steadily to term. The latter pattern is accompanied by increased production of cortisol and thyroid in the fetus. The intraluminal phase of fat digestion is immature even in the full-term neonate. Both pancreatic secretory function and bile salt metabolism mature postnatally. Despite this relative immaturity, breast milk fat is absorbed with great efficiency by the term infant, and breast milk provides other important influences on intestinal development: mitogenic factor, immunological support, control of intestinal flora. The goals of nutrition support of the premature infant have been to maintain intrauterine growth standards; yet premature infants receiving pooled breast milk from mothers at 40 weeks or more may be given too little protein for their needs. Human milk from mothers of premature infants may be a more appropriate nutrient source. Supplements with higher contents of amino acids may lead to amino acid imbalance or hyperammonaemia. Additional stresses and requirements are imposed by illness or congenital anomalies. While we must apply current research findings to clinical care, we must also extend our knowledge of extrauterine human development. The ultimate measure of success in this field will be the physical and neurological capacities of infants followed prospectively.

Aging↗