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Biomedical subjects

P Rosenthal

Publications and source records attributed to P Rosenthal.

At least 19 recordsLinked to original sources
PubMed1992

Successful late Kasai portoenterostomy.

This article describes an infant with extrahepatic biliary atresia who underwent a successful hepatoportoenterostomy at age 132 days in spite of a delay in diagnosis. Contributing to the delay in diagnosis of this case were the lack of appreciation of alcoholic stools, the presence of a gallbladder and distal common bile duct on ultrasound examination, and insufficient biopsy material for interpretation. This case emphasizes the variability in presentation and potential difficulties in diagnosis and the need for intraoperative cholangiogram and exploratory laparotomy in such cases. An approach to the patient with extrahepatic biliary atresia who is diagnosed late is discussed. A successful outcome can be achieved for such patients.

Bile Ducts↗
PubMed1992

Comparison of fecal occult blood tests for detection of gastrointestinal bleeding in pediatric patients.

To compare fecal occult blood tests (Hemoccult II, Hemoccult SENSA, HemeSelect) for detecting the presence of occult gastrointestinal bleeding in a pediatric population at high risk, we analyzed stool specimens from 100 children who followed a restricted diet. Forty-two children had upper and 58 lower gastrointestinal sources of bleeding. Positivity rates ranged from 10.8% to 26% dependent upon the occult blood test. Whereas Hemoccult II and Hemoccult SENSA slides detected several positive specimens in upper gastrointestinal bleeding sources, all HemeSelect slides were negative in these subjects. In lower gastrointestinal bleeding, HemeSelect slides were positive in 26.8% of samples as opposed to 15.9% and 17.5% positivity rates for Hemoccult II and Hemoccult SENSA, but this difference was not statistically significant. We conclude that fecal occult blood tests vary, depending upon the origin of bleeding. Our results favor use of Hemoccult SENSA slides for suspected upper gastrointestinal bleeding and HemeSelect slides for lower gastrointestinal bleeding in children. However, if only one all-purpose fecal occult blood test is to be utilized, then our data supports the use of Hemoccult SENSA slides for children.

Adolescent↗
PubMed1992

Automated total and neonatal bilirubin values in newborns: is a distinction clinically relevant?

Guidelines for managing hyperbilirubinemia in newborns were developed by using diazo methods that measure total and direct-reacting bilirubins and calculate an indirect fraction. The automated Kodak Ektachem system allows for measuring serum bilirubin by either of two dry-slide methods: TBIL, involving a modified diazo method, and NBIL, involving a dual-wavelength colorimetric method that fractionates and directly measures the unconjugated (Bu) and conjugated (Bc) bilirubins (Bu+Bc = neonatal bilirubin). The manufacturer recommends that NBIL be used in newborns less than 15 days old, which is impractical in a large, busy hospital laboratory. We compared NBIL and TBIL in 500 paired serum samples from infants less than 15 days old. We noted a statistically significant difference between TBIL and NBIL values (162.9, SD 70.4, vs 164.6, SD 69.2, mumol/L; P less than 0.0001), which was small and of no clinical significance. We conclude that TBIL values may be used with caution for newborn bilirubin screening. Furthermore, NBIL measurements are an acceptable alternative to diazo measurements for neonatal care, allowing the use of previously developed guidelines with NBIL values.

Automation↗
PubMed1992

Serum delta bilirubin estimation by an automated method.

This study compares delta bilirubin values in 40 serum samples from patients with various diagnoses, as estimated by the automated Kodak Ektachem system and measured by a manual method. Regression analysis of the results yielded a slope = 0.832, intercept = 9.9 and r = 0.724. Within-run standard deviation was 1.7 mumol/l for the automated method. In samples with predominantly unconjugated bilirubin, the Ektachem system over-estimated delta bilirubin values. In specimens with conjugated hyperbilirubinaemia, the Ektachem system and manual method were in close agreement for delta bilirubin values. We conclude that samples with predominantly unconjugated bilirubin should have the presence of delta bilirubin confirmed by the manual assay. Since the Ektachem system currently provides the only automated means of estimating delta bilirubin values, its use appears warranted.

Autoanalysis↗
PubMed1990

A gas-permeable scleral contact lens for visual rehabilitation.

We evaluated the use of a highly gas-permeable, fluid-filled scleral lens for patients with diseased corneas for whom conventional contact lens strategies failed. Fifteen patients were successfully fit with individually fabricated scleral lenses. Significant corneal hypoxia, which limited the use of previous polymethylmethacrylate scleral lenses, was not encountered. Preliminary results suggest that a gas-permeable scleral lens may offer therapeutic as well as visual benefit to some patients with severe corneal disease.

Adult↗
PubMed1990

Vocal cord paralysis and superior laryngeal nerve dysfunction in Reye's syndrome.

Bilateral vocal cord paralysis and absent laryngeal sensation are previously unrecognized sequelae for Reye's syndrome, a severe acute encephalopathy in children. Four patients were seen at varying periods ranging from 2 weeks to 5 years after their diagnosis of an episode of severe Reye's syndrome over a 20-year period at the Children's Hospital of Los Angeles (Calif). All of the patients had bilateral true vocal cord paralysis with absent laryngeal sensitivity that was documented at endoscopy. As many as 50% of survivors of severe Reye's syndrome have breathy voices or aphonia. It is suggested that some of these children may have vocal cord dysfunction that is not the result of intubation, and are at risk for aspiration and its dangerous sequelae. A vagal nuclear injury is theorized to explain the sensory motor dysfunction of the larynx in these children.

Child↗
PubMed1990

Immunogenicity of Haemophilus influenzae type B vaccines in children with hepatoportoenterostomies.

To assess the immunogenicity of HIB vaccines in patients in whom hepatoportoenterostomies were performed for biliary atresia, eight such children received Haemophilus influenzae type b-polyribosylribitol phosphate (HIB-PRP) vaccine and had pre- and postvaccination total serum anti-PRP antibody concentrations determined by radioimmunoassay. Preimmunization anti-PRP antibody levels ranged from less than 0.125 to 0.40 microgram/ml [geometric mean antibody titer (GMT) 0.106 microgram/ml], while postvaccination levels ranged from 0.161 to 1.192 micrograms/ml (GMT = 0.489 microgram/ml). Five children who did not achieve postimmunization anti-PRP antibody levels greater than 1.0 microgram/ml received 15 micrograms of either PRP coupled to diphtheria toxoid (PRP-D) or PRP coupled to an outer membrane protein complex of Neisseria meningitidis group B (PRP-NOMP) conjugate vaccine. Anti-PRP antibody levels 1 month after immunization with HIB conjugate vaccines ranged from 1.51 to 10.35 micrograms/ml (GMT = 3.386 micrograms/ml). Patients with extrahepatic biliary atresia and hepatoportoenterostomies who previously received the HIB-PRP vaccine should be revaccinated with PRP protein conjugate vaccines to ensure adequate protection against H. influenzae type b disease.

Antibody Formation↗
PubMed1990

[Post-traumatic pancreatic pseudocyst in children].

This is a report on a posttraumatic pancreas-pseudocyst of a six year old girl. The fast grow of this pancreatic pseudocyst demanded the surgical intervention in form of the cystogastrostomia. The most important factor for the decision for the operation was the sonographic imagic.

Child↗
PubMed1990

Aminotransferase as a prognostic index in infants with liver disease.

To assess the utility of the serum aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio in a group of infants with liver disorders, we retrospectively analyzed the charts of 73 infants with chronic liver disorders. Patients were considered as having either a good outcome (n = 40) or a poor outcome (n = 33), based upon the clinical course. AST and ALT in serum were measured simultaneously at the time of initial presentation and at various follow-up visits during the first 13 months after birth. At presentation (mean age 1.65 months), there was no difference in the AST/ALT ratios between the good (1.61 +/- 0.62; mean +/- SD) and poor (1.65 +/- 0.78) outcome groups (P = 0.81). However, over time, the AST/ALT ratio increased in patients in the poor-outcome group and decreased in patients in the good-outcome group. Calculating the AST/ALT ratio appears to be an easy, early, and reliable prognostic indicator for infants with hepatic disease, and may be a useful measure for evaluating liver-disease patients.

Alanine Transaminase↗
PubMed1990

Total and direct-reacting bilirubin values by automated methods compared with liquid chromatography and with manual methods for determining delta bilirubin.

This study compares total and direct-reacting bilirubin values in 40 serum samples from patients with various diagnoses, as measured by automated methods (Beckman Synchron CX-5, Beckman Astra 8, Kodak Ektachem 700) and HPLC and by a manual method for delta bilirubin. For total bilirubin, within-run CVs were less than 6%. The Ektachem 700 method underestimated bilirubin with serum samples from patients with Crigler-Najjar syndrome and from newborns in whom unconjugated bilirubin concentrations were increased but conjugated bilirubins were not present or were present only in small amounts. The Astra 8 and Synchron CX-5 methods were inaccurate with cholestatic serum samples, in which conjugated bilirubin concentrations were increased and other compounds such as bile acids could be expected to interfere. We conclude that each automated method examined provides reasonable estimates for total and direct-reacting bilirubin values for routine clinical use. The need for each laboratory to select the appropriate bilirubin method for its particular situation is obvious.

Autoanalysis↗
PubMed1990

Postatelectatic ventilation-perfusion mismatch simulating a pulmonary embolus.

Ventilation-perfusion imaging was performed on a patient with chronic intermittent atelectasis of the right lung and revealed a mismatch simulating a pulmonary embolus in the right lung. A pulmonary arteriogram revealed no evidence of embolic disease; however, there was reduced capillary phase opacification of the right lung and increased pulmonary artery pressure. The findings are consistent with an isolated right pulmonary artery hypertension secondary to prolonged atelectasis causing an apparent mismatch on the ventilation-perfusion scan.

Adolescent↗
PubMed1989

Quantitative measurements of receptive field changes during antagonism of GABAergic transmission in primary somatosensory cortex of cats.

In cortical area 3b of cats, responses of 76 single neurons to punctate indentations were recorded before and during iontophoretic administration of bicuculline methiodide (BMI), a GABAergic antagonist, at levels that did not affect spontaneous activity. Constant amplitude indentations were applied to selected sites along distal-proximal and radial-ulnar axes that intersected the most sensitive area in the receptive field. Profiles of response magnitudes were used to measure receptive field dimensions before and during antagonism of GABAergic inhibition. Blockade of GABAergic transmission caused receptive field dimensions of 48 rapidly-adapting neurons to increase an average 141%, or nearly 2.5 times their original size. Analysis of the spatial distribution of inhibition indicated that in-field inhibition was larger than surround inhibition. During BMI administration, response latency was significantly longer for response elicited from the expanded territory than for responses elicited from within the original receptive field, suggesting that receptive field expansion might be mediated by multisynaptic intracortical connections. The magnitude of receptive field expansion was independent of receptive field size or peripheral location. In a substantial number of neurons, however, BMI produced asymmetric expansions that extended only in the proximal direction. For 9 slowly-adapting neurons. BMI produced measurable increases in receptive field dimensions, but these changes were significantly smaller than the changes in rapidly-adapting neurons.

Anesthetics↗
PubMed1989

Hepatobiliary scintigraphy and the string test in the evaluation of neonatal cholestasis.

We evaluated [99mTc]diisopropylphenyl-carbamoylmethylimidodiacetic acid ([99mTc]DISIDA) cholescintigraphy with measurement of duodenal fluid radioactivity collected by the string test in patients with neonatal cholestasis. Twenty-six infants with prolonged jaundice and acholic stools were studied prospectively. Twelve patients had neonatal hepatitis, 12 biliary atresia, and one each Alagille syndrome and alpha 1-antitrypsin deficiency liver disease. All infants except the biliary atresia patients and four of the neonatal hepatitis patients revealed bowel activity on scan 6 h after tracer administration. At 24 h, three of these latter patients with neonatal hepatitis and two of the patients with biliary atresia revealed bowel activity. String radioactive counts for neonatal hepatitis ranged from 99,574 to 967,205 cpm (374,504 +/- 232,210 cpm; mean +/- SD) and for biliary atresia from 8,342 to 370,346 cpm (117,149 +/- 98,698 cpm; mean +/- SD). While neither test alone was capable of correctly differentiating among all patients, those patients with biliary atresia had either a negative hepatobiliary scan at 24 h or string radioactive count below 197,007 cpm. Disparity between the hepatobiliary scan and the string radioactive counts mandates further diagnostic investigation. These data suggest that simultaneous administration of the string test with hepatobiliary scintigraphy is advantageous in the evaluation of infants with cholestatic jaundice.

Acute Disease↗
PubMed1989

Atropine therapy and paralytic ileus in an infant.

Signs of intestinal obstruction developed in a 2-month-old infant with trisomy 21 during atropine therapy. Radiographic evaluation strongly suggested Hirschsprung's disease, but rectal biopsy yielded normal histologic results. Following cessation of atropine use, the symptoms resolved completely. This case report demonstrates the association between atropine therapy and intestinal ileus. Caution is advised when using topical atropine therapy in children, especially those with Down's syndrome.

Administration, Topical↗