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Biomedical subjects

L J Newman

Publications and source records attributed to L J Newman.

At least 37 records · Page 2Linked to original sources
PubMed1990

Cow's milk protein sensitivity during infancy in patients with inflammatory bowel disease.

Seventy-eight patients with inflammatory bowel disease (35 with Crohn's disease and 43 with ulcerative colitis) and a control population of 36 children without organic disease were surveyed to determine the frequency of symptoms compatible with cow's milk-protein sensitivity during infancy. The incidence of a history compatible with cow's milk sensitivity was 8.5% (3/35) in patients with Crohn's disease and 2.8% (1/36) in controls. Patients with ulcerative colitis had a significantly greater prevalence of symptoms, compared with the other patient groups (20.9%, 9/43; p less than 0.03). In addition, patients with a history of cow's milk allergy, who subsequently developed ulcerative colitis, did so at an earlier age (6.68 +/- 2.05 yr vs. 10.62 +/- 0.74 yr: p less than 0.02) than those without a history of cow's milk sensitivity. Thus, there appears to be a potential relationship between early cow's milk sensitivity and the development of ulcerative colitis.

Adolescent↗
PubMed1989

Gastrointestinal milk intolerance of infancy.

During a period of 30 months, cow's milk- or soy protein-induced colitis was diagnosed in 22 infants. All patients presented with hematochezia. Only three patients had substantial diarrhea. Colonoscopic evaluations demonstrated a characteristic mucosal appearance, manifested by aphthoid ulcerations with intervening, normal-appearing mucosa. Histologic findings included surface ulcerations and associated inflammation of the lamina propria and submucosa, marked by substantial eosinophilic infiltration. Both clinical symptoms and colonoscopic abnormalities rapidly resolved in all patients after the elimination of cow's milk and/or soy protein from the diet. These data indicate that hematochezia may be the predominant symptom of cow's milk protein and soy protein intolerance in many affected infants, and that colonoscopy is the most effective means of establishing a definitive diagnosis in this patient population.

Colitis↗
PubMed1989

Campylobacter pylori-related gastrointestinal disease in children. Incidence and clinical findings.

Over a one-year period, 95 children and adolescents presenting with epigastric pain and/or vomiting, and without associated risk factors for development of peptide disease, underwent endoscopic antral biopsies for pathologic diagnosis and to detect presence of Campylobacter ss. pylori (C. pylori). Additional biopsies of the esophagus, stomach, and duodenum were obtained for histologic evaluation. C. pylori was identified in 16 patients (16.8%), all of whom had evidence of acute and/or chronic gastritis. Significant discriminating factors between C. pylori-positive and -negative subjects included age at presentation (positive vs negative = 14.6 vs 9.9 years, P less than 0.01), biopsy-confirmed gastritis (100% vs 30.4%, P less than 0.001), and diagnosis of duodenitis alone (0% vs 46.8%, P less than 0.001). Risk for bacterial colonization was significantly higher in the presence of endoscopic gastritis (P less than 0.001). Among C. pylori-positive patients, none responded to standard antiulcer therapy (H2-receptor antagonists, antacids). Symptomatic and histologic remission was achieved utilizing combined therapy with bismuth subsalicylate and antibiotics. Seven of 79 C. pylori-negative patients with biopsy-proven gastritis who responded poorly to antisecretory therapy had the organism identified in follow-up antral biopsies; these patients improved clinically following treatment for C. pylori. These data suggest that C. pylori is a significant factor in the etiology of upper gastrointestinal tract inflammatory disease in pediatrics, and presence of the organism should be evaluated, particularly in children with evidence of acute and/or chronic gastritis.

Adolescent↗
PubMed1989

Use of the intraesophageal acid perfusion test in provoking nonspecific chest pain in children.

The intraesophageal acid perfusion (Bernstein) test was evaluated as a provocative test for nonspecific chest pain in children with esophagitis. Sixty patients with atypical chest pain were studied. None of the patients had heartburn or other characteristic symptoms of esophagitis. Forty-five patients had esophagitis; in 18 (40%) of these patients, pain replicating their usual symptoms developed during esophageal acid perfusion, whereas in 15 patients without esophagitis, chest pain did not develop during esophageal acid perfusion. In three patients with esophagitis, esophageal manometric abnormalities and chest pain developed as a result of esophageal acid perfusion. Treatment with either ranitidine or antacids had equivalent effectiveness. We conclude that a positive Bernstein test result in children with nonspecific chest pain indicates that the pain is likely associated with esophageal disease.

Adolescent↗
PubMed1989

Patterns of gastroesophageal reflux (GER) in patients with apparent life-threatening events.

The incidence and temporal patterns of gastroesophageal reflux (GER) in infants presenting with an apparent life-threatening event (ALTE) was compared with GER characteristics of infants evaluated for persistent emesis, utilizing continuous 24 h intraesophageal pH monitoring. These data indicate that the incidence of significant GER was similar in both groups, despite the absence of a clinical vomiting history in 46% of ALTE patients. Furthermore, infants with ALTE demonstrate a significantly higher incidence of sleep reflux when compared with control infants presenting with vomiting alone (27 vs. 0%, p less than 0.001). Awake GER beyond the first two postprandial hours was not observed in either study group. Monitoring results, therefore, indicate that significant GER is common in infants with ALTE; and these infants manifest an apparently unique pattern of GER distinct from that observed in age-matched controls with GER alone. Possible relationships between GER in ALTE patients and the development/onset of apneic episodes are discussed.

Apnea↗
PubMed1989

Ontogeny of basolateral membrane lipid composition and fluidity in small intestine.

To evaluate physicochemical properties of the small intestinal basolateral cell surface during postnatal development, membranes were isolated from suckling (14-17 days) and weanling-mature (35-49 days) rabbit jejunal and ileal enterocytes at 30- to 40-fold purification (based on Na+-K+-ATPase specific activity) and with limited contamination from coisolated cellular elements. Membrane lipid analysis demonstrated age-dependent reductions and proximal to distal increases in total lipid (per milligram protein). Postnatal increases in membrane total cholesterol of jejunum (suckling vs. mature, 0.18 vs. 0.26 mumol/mg protein; P less than 0.01) and ileum (0.18 vs. 0.31 mumol/mg protein; P less than 0.01) resulted in markedly higher cholesterol-to-phospholipid molar ratios (jejunum, 0.43 vs. 0.73; ileum, 0.43 vs. 0.72 mumol/mg protein; P less than 0.01). Membranes from mature animals had higher relative sphingomeylin and phosphatidylcholine content and, in both age groups, fatty acyl saturation was increased in ileum compared with jejunum. By utilization of the fluorophores 1,6-diphenyl-1,3,5-hexatriene and DL-12-(9-anthroyl)stearic acid, the fluidity of basolateral membranes and liposomes prepared from extracted membrane lipid decreased markedly in mature rabbits. Arrhenius plots demonstrated higher apparent thermotropic transition temperatures of mature membrane lipid. These data therefore demonstrate significant changes in small intestinal basolateral membrane lipid composition and fluidity that occur during the weaning period. Possible relationships to ontogenesis of membrane protein function are discussed.

Animals↗
PubMed1989

Gastroesophageal reflux-induced hypoxemia in infants with apparent life-threatening event(s).

To evaluate relationships between gastroesophageal reflux (GER) and the development and onset of apparent life-threatening event(s) (ALTE), 16 infants presenting with ALTE and 6 control subjects manifesting clinical GER alone were studied using prolonged, esophageal pH monitoring in conjunction with simultaneous pulse oximetry and transthoracic impedance pneumocardiography. Despite the absence of a clinical vomiting history in 14 of 16 patients with ALTE, the incidence of GER was similar in both groups (patients with ALTE vs control subjects, 95% vs 100%). Significant arterial oxygen desaturation (less than 90% for greater than 3 minutes) was monitored during 60 episodes in 14 of 16 infants with ALTE, compared with no episodes of reduced arterial oxygen saturation in control subjects. Fifty-four of 60 of these desaturation events commenced within 3.9 +/- 0.4 minutes (mean +/- SD) of onset of a drop in esophageal pH to less than 4.0. Linear regression analysis indicates a significant correlation between duration of esophageal acidification and length of individual hypoxemic episodes (r = .39). Pneumocardiograms were normal in all patients. These data suggest that unsuspected GER is common in infants presenting with ALTE and, in these patients, GER may be directly associated with reflex hypoxemic episodes. Prolonged intraesophageal pH monitoring, performed simultaneously with evaluation for apnea, should be considered in all infants presenting with ALTE.

Apnea↗
PubMed1988

Emergency ultrasound in the evaluation of acute-onset abdominal pain in children.

The diagnostic efficacy of abdominal ultrasound obtained within 72 hours of admission in children with undiagnosed, acute-onset abdominal pain was studied. In our 54 patients, sonogram supported the clinical diagnosis in 22 patients (40.7%), established a previously unsuspected diagnosis in nine (16.6%), and was normal in 23/54 (42.6%). Twenty-one of the patients with a normal study recovered uneventfully. Two patients had a false negative study (sensitivity of 91%) and in three, the study was falsely positive (specificity 90.3%). Thus, our data suggest that emergency abdominal ultrasound may be of significant diagnostic value in the evaluation of children with acute-onset abdominal pain.

Abdomen, Acute↗
PubMed1988

Chest pain of gastrointestinal origin.

Twenty seven children who had been diagnosed as having idiopathic chest pain were investigated to find out if the pain was of gastrointestinal origin. The symptoms had lasted from two weeks to eight months. In 21 of the 27 children (78%) the chest pain had a gastrointestinal cause: 16 had oesophagitis, four had gastritis, and one had diffuse oesophageal spasm. All patients responded to medical treatment of their gastrointestinal symptoms, resulting in disappearance of the chest pain.

Adolescent↗
PubMed1988

Gastroesophageal reflux associated with nemaline myopathy of infancy.

A severe infantile form of nemaline myopathy has a high mortality rate when untreated because of subsequent malnutrition and respiratory failure. Three infants with this condition demonstrated persistent vomiting, poor weight gain, and recurrent pneumonias. Esophageal manometry demonstrated decreased lower esophageal sphincter pressures and low amplitude peristalsis; 24-hour esophageal pH monitoring revealed significant gastroesophageal reflux. Medical therapy was ineffective in relieving symptoms. After antireflux surgery, vomiting and respiratory symptoms ceased, and there was no longer significant gastroesophageal reflux during pH monitoring. Our experience indicates that in some infants with nemaline myopathy a severe form of gastroesophageal reflux develops that is not responsive to medical therapy. Early surgical intervention may decrease life-threatening complications associated with gastroesophageal reflux in these infants.

Biopsy↗
PubMed1986

Gastroesophageal reflux secondary to gastrostomy tube placement.

We evaluated five children with severe psychomotor retardation who developed frequent vomiting and poor weight gain after surgical placement of a feeding gastrostomy tube. Prolonged pH probe testing before surgery did not reveal notable gastroesophageal reflux (GER). Treatment with 12-hour gastrostomy tube feeding resulted in a marked reduction in vomiting; after one year of continuous feeding, all patients had achieved significant weight gain (mean, 44.0%). Esophageal manometrics and 24-hour pH probe testing before and at the end of the 12-month continuous-feeding period demonstrated low pressures of the lower esophageal sphincter and significant GER in the five children studied. These results indicate that children may develop symptomatic GER after gastrostomy tube placement. In such patients continuous gastrostomy tube feeding may result in a cessation of vomiting and achievement of significant weight gain. Definitive antireflux surgery can then be performed with the patient in an improved nutritional state.

Adolescent↗
PubMed1985

Mucus glycoprotein fatty acyltransferase in patients with cystic fibrosis: effect on the glycoprotein viscosity.

The presence of an acyltransferase activity which catalyzes the transfer of palmitic acid from palmitoyl coenzyme A to mucus glycoprotein has been demonstrated in the microsomal fraction of human rectal mucosa. The activity of this enzyme in the mucosa of patients with cystic fibrosis (CF) was found to be 3.5 times higher than that from normal individuals. The CF mucus glycoprotein in comparison to that of normal contained 1.3 times more associated lipids and 6 times more covalently bound fatty acids. The viscosity of the intact CF glycoprotein was 1.8 times higher than that of normal glycoprotein. Extraction of associated lipids led to 3-fold drop in the viscosity of CF glycoprotein and 5-fold drop in the case of normal glycoprotein. Further loss in the viscosity occurred following removal of the covalently bound fatty acids. The viscosity of such modified CF mucus glycoprotein was only about 10% higher than that of similarly treated normal glycoprotein.

Acetyl-CoA C-Acyltransferase↗
PubMed1985

Colonic variceal bleeding in a child.

A 5-year-old girl with biliary atresia is described who developed lower gastrointestinal bleeding from colonic varices. Vasopressin infusions temporarily controlled the bleeding. Following a right hemicolectomy the bleeding has not recurred.

Child, Preschool↗
PubMed1985

A new ambulatory system for extended esophageal pH monitoring.

A new 24-h ambulatory esophageal pH monitoring system (AMBI 24) was evaluated in 72 pediatric patients with suspected gastroesophageal reflux (GER). Forty-seven of these patients were monitored at home and the other 25 in our hospital. This system was employed without complication in infants and a full range of pediatric patients, as well as in older children with severe psychomotor delay. The data obtained were consistent with those reported utilizing standard monitoring equipment, and the results served as the basis for subsequent medical management. The results of this study, therefore, suggest that this method of esophageal pH monitoring is a safe and effective means of evaluating GER while allowing for patient mobility.

Adolescent↗