Biomedical subjects
J Puntis
Publications and source records attributed to J Puntis.
Case report by Lehrnbecher.
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Errors by paediatric residents in calculating drug dosages.
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The battle with scurvy.
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Economics of home parenteral nutrition.
The past 30 years have seen long term parenteral nutrition evolve from a novel technique to an accepted intervention for gastrointestinal failure. The development of home parenteral nutrition (HPN) has parallelled a shift in resources from hospital to community care and has been driven by technological advances, the growth of commercial home care companies and patient choice. Costs for HPN per patient year have been estimated to range from $US 150,000 to $US 250,000 in the US, and are around 55,000 pounds in the UK, perhaps only 25 to 50% of in-hospital costs. In the absence of any alternative treatment for many patients with gastrointestinal disease, parenteral nutrition is life saving and offers the prospect of maintaining a good quality of life. The cost of 1 quality-adjusted life-year for HPN has been estimated as 69,000 pounds in the UK (1995 values), and $Can 14,600 in Canada (1984 values), making HPN relatively cost effective compared with other ways of spending money to improve health. HPN is also given to patients in whom life expectancy is unlikely to be influenced, such as those with cancer or AIDS. Although there is considerable heterogeneity between countries in the proportion of HPN patients with a particular disease, malignancy is now the single most common indication. HPN can be expected to improve quality of life over a short period of terminal care, and whilst a strong case can be made for use of HPN in some of these patients, its use has not been subjected to detailed medical or economic appraisal.
Diagnosis of exocrine pancreatic insufficiency in cystic fibrosis by use of fluorescein dilaurate test.
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Long term prognosis of Crohn's disease with onset in childhood and adolescence.
The long term outcome has been determined in 67 children with Crohn's disease whose symptoms started at or before 16 years of age. The mean period of follow up was 15.0 years (range 1.5-47 years). The number of children diagnosed in each quinquennium has not increased. Nearly all patients had gastrointestinal symptoms at presentation, but in some cases these were only elicited on careful enquiry. Only four children presented with growth retardation alone. Twenty one per cent of the children had diffuse small bowel disease at onset or during the period of review and posed major problems in management with high morbidity and mortality. They were generally treated medically to suppress disease activity and surgical intervention was restricted to resection of local stricture formation. The outcome in distal ileal +/- right colonic disease was similar to that in the adult. Patients with colonic disease (27% of total) were treated medically but 83% required surgical resection after a mean interval of only four years (range 0-9 years). Growth failure occurred in 21 children (height and weight less than 3rd centile) and 11 of these had a period of catch up growth; 10 after resection (ileal +/- right colon resected, eight; colonic resection, two) and one after medical treatment. Ten have permanent growth and height retardation, of whom four had diffuse small bowel disease and three had early recurrence after surgical resection. Nine children have died during the period of review, of whom six had diffuse small bowel disease. Despite the high morbidity, 38 of the 58 survivors are now well with no evidence of recurrent disease. A further 14 are well, but with radiological evidence of residual (colon, three; diffuse small bowel, eight) or recurrent (three) disease. Only six have symptomatic disease at present.