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Biomedical subjects

M Glassman

Publications and source records attributed to M Glassman.

At least 37 records · Page 2Linked to original sources
PubMed1991

Immunology of inflammatory bowel disease: summary of the proceedings of the Subcommittee on Immunosuppressive Use in IBD.

As outlined, scanty data exist with regard to immunologic therapy in children with IBD despite the fact that the pediatric population affords a unique opportunity for clinical evaluation. Children are less affected by modifying conditions such as smoking, alcohol ingestion, and the long-term use of medications, and because of their specific needs for ponderal and linear growth, children might benefit most from immunological therapy that has been proven to be steroid sparing. Therefore, clinical trials to evaluate the efficacy of 6-MP and/or azathioprine in growing children with Crohn's disease would appear to provide a fruitful avenue for collaborative research. Efforts to organize a multicenter evaluation of these agents have been initiated. The studies are crucial in evaluating the efficacy and safety of immunosuppressive therapy in the pediatric population with IBD.

Aminosalicylic Acids↗
PubMed1990

Treatment of type IIa hyperlipidemia in childhood by a simplified American Heart Association diet and fiber supplementation.

Thirty-six children identified as having primary type IIa hypercholesterolemia were treated with a diet restricting the intake of saturated fat to 10% of total energy and supplemented with soluble fiber for 8.1 +/- 2.4 (mean +/- SEM) months. In 14 of 36 patients first treated with the American Heart Association "Step-One" diet for 8.0 +/- 1.1 months, total cholesterol level dropped from 257.9 +/- 15.8 mg/dL to 240.6 +/- 10.9 mg/dL; the low-density lipoprotein cholesterol level dropped from 191.8 +/- 17.4 mg/dL to 175.0 +/- 11.7 mg/dL; the high-density lipoprotein cholesterol level dropped from 42.8 +/- 1.94 mg/dL to 41.6 +/- 1.68 mg/dL; and triglyceride concentration rose from 115.9 +/- 13.7 mg/dL to 128.1 +/- 14.1 mg/dL. The 36 patients treated with saturated fat-restrictive diets and supplemental soluble fiber diets had a reduction of total cholesterol levels from 249.2 +/- 7.66 mg/dL to 207.1 +/- 6.31 mg/dL and a low-density lipoprotein cholesterol level reduction from 184.7 +/- 7.55 mg/dL to 142.6 +/- 6.7 mg/dL, a reduction of 18% and 23%, respectively. There was no significant change in high-density lipoprotein cholesterol levels (46.4 +/- 1.9 mg/dL vs 44.3 +/- 2.1 mg/dL) or in triglyceride concentrations (94.2 +/- 7.43 mg/dL vs 102.2 +/- 8.45 mg/dL). In addition, the reduction in serum lipoprotein concentrations resulting from this program was significantly greater than the concentrations resulting from the American Heart Association diet alone. The different responses to these regimens suggest that a simplified diet and soluble fiber supplementation is well tolerated and reduces total and low-density lipoprotein cholesterol levels more effectively than the standard American Heart Association diet in children.

American Heart Association↗
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

Individual and aggregate level change in sexual behavior among gay men at risk for AIDS.

Until an effective vaccine or treatment for AIDS is developed, the rate of spread of the epidemic will be determined primarily by the willingness of infected and at-risk individuals to refrain from behaviors implicated in the spread of the disease. Consequently, public health efforts have focused on educating these populations about the dangers inherent in certain practices. To date, the impact of these educational activities has been most extensively studied with regard to gay and bisexual men. Researchers, however, seem not always to appreciate the necessity to examine change at two levels of analysis--the individual and the aggregate because it is possible to draw different but valid conclusions about the nature of change, depending upon the level of analysis used. A series of models for examining individual and aggregate level change are described. These models are then used to examine whether there is evidence of change over a 6-month period in the sexual behavior of a sample of gay men from New York City. The data reveal evidence of a significant trend in the direction of safer sexual behavior at both the individual and aggregate level.

Acquired Immunodeficiency Syndrome↗
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↗
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

Kernberg and Kohut: a test of competing psychoanalytic models of narcissism.

Over the past ten years the problem of validating psychoanalytic theory has received increasing attention from psychoanalysts and nonpsychoanalysts alike. Yet, very little research responsive to this question of validation has been produced. During this same period one of the most fertile controversies in contemporary psychoanalysis reached its peak--the Kernberg-Kohut debate concerning the nature of narcissism. However, for the lack of a validation strategy, this debate has become increasingly sterile, degenerating to a theoretical stalemate at this point. This paper addresses the problem of validation by using causal modeling as a mechanism for empirically testing many of the claims of these competing models of narcissism. Although the data provide empirical support for both theories, strategic comparisons tentatively suggest that Kohut's self psychology is more parsimoniously explained as a special case of Kernberg's ego psychology-object relations theory.

Adult↗
PubMed1987

Diagnostic utility of hepatobiliary scintigraphy with 99mTc-DISIDA in neonatal cholestasis.

We retrospectively evaluated the utility of hepatobiliary scintigraphy and various clinical factors in differentiating intrahepatic cholestasis from biliary atresia in 28 consecutive infants with neonatal cholestasis. One millicurie of technetium-labeled diisopropyliminodiacetic acid (DISIDA) was administered intravenously, and images were obtained for up to 24 hours or until gastrointestinal excretion was noted. Nine separate studies in seven infants with biliary atresia were correctly interpreted as showing no gastrointestinal excretion of radionuclide. Of the 21 patients with intrahepatic cholestasis, only nine had gastrointestinal excretion on the first study; in eight without excretion, a second study was done, and five of these showed gut excretion. All infants with either neonatal hepatitis (six) or inspissated bile syndrome (three) had demonstrable gastrointestinal excretion either on the first or second DISIDA study. However, five of six infants with paucity of intrahepatic bile ducts, two of six infants with cholestasis secondary to total parenteral nutrition, and one infant with cholangiolitis did not show evidence of gastrointestinal excretion. The mean birth weight, mean gestational age, and mean weight at study were significantly greater (P less than 0.005) for infants with biliary atresia without excretion than for infants with intrahepatic cholestasis without excretion. The mean direct bilirubin concentration was 6.0 mg/dL for both infants with biliary atresia and infants with intrahepatic cholestasis without excretion; however, infants with excretion had a significantly lower (P less than 0.02) mean direct bilirubin value of 3.4 mg/dL. Excretion was noted in four infants with total bilirubin values greater than 10.0 mg/dL. The absence of gut excretion on the first DISIDA study was 100% sensitive but only 43% specific for biliary atresia. In infants without gut excretion of DISIDA, birth weight greater than 2200 g was 100% sensitive and 92% specific for biliary atresia. We conclude that DISIDA scanning, together with clinical data, is useful in differentiating extrahepatic from intrahepatic cholestasis. The absence of gut excretion on the first DISIDA study does not necessarily indicate extrahepatic obstruction; the study should be repeated if the diagnosis is not clear.

Bile Ducts, Intrahepatic↗
PubMed1984

Whole body nitrogen kinetics in man: determination from plasma [guanidino-15N]arginine.

Whole body nitrogen turnover and protein synthesis were calculated by the method of D. Picou & T. Taylor-Roberts [Clinical Science and Molecular Medicine (1969) 36, 283-296] except that plateau plasma enrichment of [guanidino-15N]arginine was used in place of the [15N]urea enrichment after a constant infusion of [15N]-glycine. With this approach metabolic pool turnover and protein synthesis were 637.2 +/- 73.0 mg of N day-1 kg-1 and 2964.0 +/- 409.5 mg of protein day-1 kg-1 respectively. Virtually identical isotopic enrichment in [guanidino-15N]arginine and [15N]urea were observed in a healthy young adult who took repeated oral doses of [15N]glycine for a period of 60 h: 0.47 (arginine) and 0.48 (urea) atom% excess. The turnover of glycine nitrogen and of urea, determined from the constant infusion of [15N]glycine and [13C]urea, was 66.2 +/- 3.3 mg of N day-1 kg-1 and 156.2 +/- 4.3 mg of urea day-1 kg-1 respectively. The ratio of steady-state enrichment in arginine to that in glycine, reflecting the fraction of arginine derived from glycine, was 10.5%. By using the [guanidino-15N]arginine enrichment as representative of the expected enrichment in [15N]urea at plateau, it was calculated that approximately 25% of glycine N flux is directed toward the synthesis of urea, with the remainder directed to protein and quantitatively minor products like haem and creatinine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Antenatal diagnosis and early surgery for choledochal cyst.

The pathogenesis and optimal treatment of choledochal cyst have long remained questions of considerable speculation and dispute. Because the pregnancy of a 37-year-old woman was felt to be at risk, five antenatal ultrasound examinations were made. The fourth examination at 31.5 weeks of gestation demonstrated a choledochal cyst. Following birth, the child was studied with repeat ultrasound examinations and scintigraphy. The results of these studies plus the findings at surgery contributed new evidence regarding the possible pathogenesis and optimal treatment of choledochal cysts. Although the time at which the cyst originated is compatible with the concept of reflux of pancreatic juice into the common duct, no abnormal junction of the pancreatic and common duct was identified. No evidence of obstruction as part of the pathogenesis could be demonstrated. Progressive changes in the choledochal cyst in the first ten days of life suggested that delay in diagnosis and treatment of a choledochal cyst may contribute to early complications such as cholangitis. Early excision of the cyst in the newborn is considered to be the optimal treatment and may pose less risk to the patient than delayed surgical exploration.

Common Bile Duct Diseases↗
PubMed1983

High incidence of hypogammaglobulinemia in infants with diarrhea.

Examination of 136 children who were referred to the Pediatric Gastroenterology Clinic at Yale-New Haven Hospital for chronic or severe diarrhea between 1977 and 1981 revealed that 31 patients (22.8%) had serum immunoglobulin levels below the 5th percentile for age. Twenty-four of these 31 patients (77.4%) had normal or near normal serum immunoglobulin levels by their third birthday and most could therefore be classified under the heading "transient hypogammaglobulinemia of infancy," an unexpected finding, as this condition has previously been thought to be rare; only 27 patients with this disorder were reported prior to 1978. While the basic cause of the defect is unknown, it has been linked to a slower than normal maturation of the neonate's ability to secrete immunoglobulins. Comparison of our patients with hypogammaglobulinemia and those with chronic diarrhea but normal immunoglobulins revealed that the former group are younger at presentation (mean, 8.2 months) and at the onset of their diarrhea (3.1 months); the figures for patients without hypogammaglobulinemia were 18.2 and 8.2 months, respectively. Males and females were equally affected, and the diarrhea, which was responsive to a hypoallergenic diet, resolved by 3 years of age as did the hypogammaglobulinemia in nearly all cases. While the etiology of the diarrhea remains obscure, significant problems outside the gastrointestinal tract did not occur. Circumstantial evidence suggests that the most likely cause for the failure of production of IgG, and to a lesser extent IgA antibody, in infants seen with diarrhea may result from a failure of maturation of T cell helper systems rather than any intrinsic defect in the B cell system itself.

B-Lymphocytes↗
PubMed1981

Severe hypertension in a child with ganglioneuroblastoma.

A 26-month-old boy with Stage III abdominal ganglioneuroblastoma had tachycardia and hypertension. The hypertension increased following the institution of chemotherapy and necessitated the use of both alpha and beta adrenergic blocking agents to control the effects of the marked catecholamine production. After excision of the residual tumor, the blood pressure and urinary catecholamine excretion returned to normal. Histologic examination of this tissue under light microscopy revealed some sections of ganglioneuroblastoma as well as large areas of ganglioneuroma. Examination by electron microscopy demonstrated a moderate number of dense core neurosecretory-type granules in the cell bodies of the ganglion-like cells and an abundance of the same type of granules in the bundles of the interwoven cytoplasmic neural processes. To data, 32 months after diagnosis and 20 months off chemotherapy, the patient remains free of tumor and is in excellent general health. We postulate that the large number of secretory granules in this tumor permitted storage and release of markedly increased quantities of norepinephrine and resulted in a clinical profile similar to that associated with pheochromocytoma.

Abdominal Neoplasms↗
PubMed1981

Pancreatitis in patients with Reye's syndrome.

Three patients who died of a Reye's syndrome had biochemical or pathological evidence of pancreatitis. None of the 38 survivors had clinical or biochemical evidence of pancreatic dysfunction. The use of hypertonic glucose solutions and exogenous insulin may reverse the metabolic abnormalities seen in Reye's syndrome and may spare the pancreas, thereby preventing the development of pancreatitis. In addition, serum calcium and glucose concentrations appear to correlate with pancreatic function and may be of value in detecting the occurrence of pancreatitis. It is our impression that the development of pancreatitis protends a poor prognosis in patients with Reye's syndrome.

Adolescent↗