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Biomedical subjects

R B Colletti

Publications and source records attributed to R B Colletti.

At least 37 records · Page 2Linked to original sources
PubMed1993

Niacin treatment of hypercholesterolemia in children.

OBJECTIVE: To determine the efficacy and adverse effects of niacin treatment of hypercholesterolemia in children. DESIGN: Retrospective review. SETTING: Two university hospital referral clinics. PATIENTS: All children who received single-drug niacin treatment for severe hypercholesterolemia between 1980 and 1991. RESULTS: Twenty-one children, aged 4 to 14 years, were treated with niacin, 500 to 2250 mg daily. Pretreatment total serum cholesterol value (mean +/- SD) was 7.84 +/- 1.14 mmol/L (303 +/- 44 mg/dL), and low-density lipoprotein cholesterol value was 6.28 +/- 1.16 mmol/L (243 +/- 45 mg/dL). Niacin treatment in daily doses > 1000 mg reduced total cholesterol by 23% and low-density lipoprotein cholesterol by 30% (P < .001) but had no effect on high-density lipoprotein cholesterol and triglycerides. As in adults, reversible adverse effects were common, occurring in 16 (76%) of the 21 children. Six children (29%) had reversible dose-related elevations of serum aminotransferase levels. Niacin therapy was discontinued in 8 children (38%) because of flushing, abdominal pain, vomiting, headache, or elevated serum aminotransferase levels. CONCLUSIONS: This study suggests that although niacin treatment in children is efficacious, adverse effects are common. Until further study demonstrates long-term safety, niacin treatment should be reserved for the closely-supervised treatment of severe hypercholesterolemia by a lipid specialist.

Adolescent↗
PubMed1991

Autoimmune enteropathy and nephropathy with circulating anti-epithelial cell antibodies.

We describe a child with circulating anti-epithelial cell antibodies, autoimmune enteropathy with intestinal villous atrophy, and membranous glomerulonephritis. The patient had persistent diarrhea at 6 months of age, and a small bowel biopsy showed active enteritis, villous atrophy, and crypt hyperplasia. When the patient was, 10 months of age, nephrotic syndrome developed because of membranous glomerulonephritis. Results of tests for circulating immune complexes were negative. Indirect immunofluorescence studies revealed a circulating antibody directed against renal epithelial cells. Circulating antibodies directed against normal small intestine epithelial cells were also detected by the immunoperoxidase technique. Western blot and immunoprecipitation identified a 55-kd antigen, in both small bowel and kidney, that reacted with an antibody in the patient's serum. High-dose prednisone therapy induced a clinical remission, resolution of the small bowel injury, and diminished serum anti-epithelial cell antibodies; after dose reduction, clinical relapse occurred with villous atrophy and reappearance of anti-epithelial cell antibodies. When the patient was 45 months of age, persistent diarrhea recurred despite intravenous administration of corticosteroids, cyclosporine, and total parenteral nutrition. Autoantibodies to a 55-kd epithelial cell protein are temporally related to the development of enteropathy and nephropathy. Study of similar patients is needed to determine the role of such antibodies in this disorder.

Atrophy↗
PubMed1991

Effect of obesity on plasma insulin-like growth factor-I in cancer patients.

Starvation and malnutrition are associated with low concentrations of plasma insulin-like growth factor I (IGF-I). To evaluate the utility of IGF-I as a screening test for malnutrition, we compared plasma IGF-I concentrations with anthropometric measurements of nutritional status in 99 cancer patients. Forty-three percent of patients were overweight and 4 percent were underweight. Log IGF-I correlated negatively with body weight (r = -0.31, P = 0.002), midarm muscle area (MAMA) (r = -0.31, P = 0.001), triceps skinfold thickness (TSF) (r = -0.24, P = 0.03) and body mass index (r = -0.31, P = 0.003). In males plasma IGF-I correlated with TSF but not MAMA; in females IGF-I correlated with MAMA but not TSF, suggestive of a sexual dimorphism between plasma IGF-I and indices of adiposity. We conclude that obesity was far more prevalent than undernutrition, and that plasma IGF-I correlated negatively with indices of adiposity in a gender specific fashion. Because IGF-I is significantly reduced in the obese as well as in the malnourished, measurements of plasma IGF-I are unlikely to be of adequate clinical specificity to serve as a useful screening test for subtle alterations in nutritional status.

Adult↗
PubMed1990

The relationship between insulin-like growth factor-I, adiposity, and aging.

Aging is associated with both a relative accumulation of body fat and a reduction in growth hormone (GH) secretion. This study was devised to investigate the relationship between plasma insulin-like growth factor-I (IGF-I), an index of GH secretion, and anthropometric indices of body fat in normal subjects of various ages. Somatic and biochemical indices of nutrition were assessed in 107 subjects between the ages of 17 and 83 years who attended an outpatient clinic for general health supervision. Plasma IGF-I correlated negatively with age in both males (r = -.44, P = .001) and females (r = -.40, P = .005). In addition, plasma IGF-I correlated negatively with body mass index (BMI) (r = .35, P = .006), percentage of standard triceps skinfold (TSF) (r = -.26, P = .05), and percentage of standard weight (r = -.35, P = .006) in males, but not in females. Multiple regression analysis indicated that in males, BMI and percentage of standard weight correlated with plasma IGF-I independent of the effect of age. We conclude that adiposity and aging are independently associated with decreased plasma IGF-I concentrations. The negative correlations between indices of adiposity and IGF-I were observed only in males, whereas the age-associated decline in IGF-I was present in both males and females. We speculate that sex differences in the gonadal steroid milieu, combined with declining GH secretion in both sexes, may contribute to the age-associated development of obesity in males.

Adipose Tissue↗
PubMed1990

Infant temperament and school age behavior: 6-year longitudinal study in a pediatric practice.

We conducted a retrospective cohort study in a pediatric practice to assess the association between parents' ratings of temperamental difficulty (observations of specific infant behaviors) and perceptions of temperamental difficulty (impressions of one's infant as compared with other infants) in infancy and behavior problems at school age. Mothers of 129 infants, who had completed the Revised Infant Temperament Questionnaire at the 4-month visit, completed the Child Behavior Checklist when the child was 6 years of age. Teachers of 102 of these children completed the teacher Child Behavior Checklist. Temperamental difficulty was defined by assessments of rhythmicity, approach/withdrawal, intensity, mood, and adaptability. Initial analyses revealed that low socioeconomic status (r = -.29, P = .001), ratings of temperamental difficulty (r = .17, P = .06), and perceptions of temperamental difficulty (r = .22, P = .02) at 4 months of age were associated with increased maternal rating of behavior problems at 6 years of age (all 2-tailed tests). However, a multivariate regression analysis showed only low socioeconomic status (P less than .01) and increased perceptions of temperamental difficulty (P = .02) associated with maternal behavior problem scores. Teacher behavior problem scores were associated only with low socioeconomic status (r = -.27, P = .01). These results suggest that the link between difficult infant temperament and later behavior problems is complex and probably reflects both child factors and parent attitudes about what constitutes typical infant behavior.

Child↗
PubMed1989

Effect of tamoxifen on plasma insulin-like growth factor I in patients with breast cancer.

Human breast cancer cells secrete and have membrane receptors for insulin-like growth factor I (IGF-I), a growth hormone-dependent peptide that stimulates cell replication. However, little is known about plasma concentrations of IGF-I in breast cancer patients. Plasma IGF-I levels are decreased in malnutrition, decline with advancing age, and are influenced by estrogen. We evaluated the effect of the antiestrogen agent tamoxifen on plasma IGF-I in 32 ambulatory breast cancer patients. Treatment with tamoxifen was associated with lower concentrations of plasma IGF-I (0.48 +/- 0.3 unit/ml in treated versus 1.03 +/- 0.6 units/ml in nontreated patients, P less than 0.01). However, patients treated with tamoxifen did not differ from nontreated patients in age, menopause, duration since diagnosis, metastatic disease, recent weight loss, or measures of nutritional status. We conclude that tamoxifen therapy results in a reduction of plasma IGF-I concentration. We speculate that the antitumor action of tamoxifen in breast cancer is due in part to suppression of IGF-I.

Adult↗
PubMed1989

Collagenous gastritis.

Subepithelial fibrosis has previously been reported in the small intestine (collagenous sprue) and colon (collagenous colitis). We report a 15-yr-old girl with chronic gastritis and subepithelial fibrosis of the gastric corpus who presented with recurrent abdominal pain and acute upper gastrointestinal bleeding. Nodularity and erythema of the gastric corpus were persistent endoscopic findings. Biopsies revealed patchy chronic active gastritis with a striking focal thick band of collagen immediately beneath the surface epithelial cells that did not extend to deeper portions of the lamina propria. Contrast radiography demonstrated an abnormal mucosa of the gastric corpus with a mosaiclike surface pattern. Numerous studies have failed to elucidate the etiology. Despite treatment with ranitidine, sucralfate, and furazolidone, there has been no clinical or pathologic improvement. The pathogenesis and prognosis of collagenous gastritis, and its relationship to collagenous sprue and collagenous colitis, remain to be defined.

Adolescent↗
PubMed1989

Recurrent infantile vomiting due to intentional ipecac poisoning.

Recurrent vomiting is a common symptom in infancy that, when severe, may prompt an extensive diagnostic evaluation. We report a 1-year-old infant whose recurrent vomiting eluded diagnosis until ipecac syrup was detected in vomitus and urine. Separation of the infant from the mother resulted in complete resolution of the symptoms. In Munchausen syndrome by proxy, a disorder in which a mother fabricates or induces illness in her child, most reported fatalities are due to intentional poisoning. In atypical cases of recurrent vomiting, early screening of body fluids for unexpected drugs, particularly ipecac, may prevent potentially fatal delays in diagnosis.

Female↗
PubMed1986

Gastric outlet obstruction in chronic granulomatous disease of childhood.

A patient was diagnosed with gastric outlet obstruction (GOO) 17 months after the neonatal diagnosis of chronic granulomatous disease (CGD). Gastric outlet obstruction was the first clinical manifestation of CGD in this patient. Twenty-three percent of the 17 patients with GOO complicating CGD described in the literature were found to present with GOO before any other clinical manifestations of CGD. The diagnosis of GOO can be established by ultrasound and, if necessary, upper gastrointestinal roentgenogram or gastroscopy. A nonsurgical approach to management is suggested. The diagnosis of CGD should be considered in an infant or child who has GOO.

Child, Preschool↗
PubMed1986

Longitudinal evaluation of a statewide network of hospital programs to improve child passenger safety.

As a project begun in 1979 to improve child passenger safety, a statewide network of hospital-based car safety seat rental and education programs was implemented by a coalition of volunteers, nurses, physicians, and state agencies. A car safety seat program was established at every hospital delivering newborns. To evaluate the effectiveness of this network of programs, 1,846 newborns (87% of hospital discharges) were observed at discharge at ten hospitals during 33 observation studies from 1979 to 1984. Mean correct car safety seat usage increased from less than 21% in 1979 to 82% in 1984. Concurrently, use of the dangerous lap or arms position decreased from 70% preprogram to 6% postprogram, and incorrect car safety seat usage decreased from 28% to 3%. In addition 1,597 children from 0 to 3 years of age were observed at an annual county fair from 1982 to 1984. Use of either a vehicle seat belt alone or car safety seat with harness and seat belt increased from 34% in 1982 to 67% in 1984. Car safety seat and seat belt misuse occurred in 42% of infants less than 1 year of age and 20% of children 1 to 3 years of age. These findings suggest that a network of hospital-based car safety seat rental and education programs is an effective means of improving the passenger safety of newborns, infants, and young children.

Child, Preschool↗
PubMed1984

A statewide hospital-based program to improve child passenger safety.

A statewide network of hospital-based low-cost car seat rental and educational programs, operated by volunteers, was begun in Vermont in 1979. In four years the rate of correct car seat usage by newborns at hospital discharge increased from less than 16% to 71%. High usage rates appear to continue in the first two years of life. It is hypothesized that availability of car seats, direct educational intervention in the hospitals, high visibility, and indirect educational processes in the community contributed to these changes. It is concluded that hospital-based programs should be included in comprehensive strategies to improve child passenger safety.

Automobiles↗
PubMed1983

Hospital-based rental programs to increase car seat usage.

The ability of hospital-based car seat rental programs to provide car seats inexpensively throughout an entire state and the effect of these rental programs on car seat usage by newborns were evaluated. In July 1979 individuals and groups committed to child passenger safety formed a coalition called Vermont SEAT (Seatbelts Eliminate Automobile Tragedies). During the next 3 years SEAT asked the major hospitals in the state to allow volunteers to operate car seat rental programs on their premises. The number of rental programs increased from 0 to 13; the percentage of newborns born in a hospital with a rental program increased from 0% to 99%. The estimated statewide rate of car seat usage by newborns, based on observations at discharge at five hospitals, increased from 15% to 70%. These findings suggest that a network of hospital-based car seat rental programs operated by volunteers can make car seats readily available throughout a state or region, and can significantly increase car seat usage by newborns. It is recommended that such programs be a part of comprehensive strategies to improve child passenger safety.

Health Education↗
PubMedDate not supplied

Reversible valproate fulminant hepatic failure.

Valproate fulminant hepatotoxicity, usually fatal, is believed to be idiosyncratic and metabolic without an immunologic basis. There are no previous reports of a hypersensitivity reaction among numerous cases of fatal valproate fulminant hepatitis. Little is known about the electron microscopical features of valproate hepatitis. We report a case of reversible fulminant hepatitis attributable to valproate with clinical and histological characteristics of a hypersensitivity reaction. Electron microscopical findings included microvesicular steatosis with normal-appearing mitochondria.

Chemical and Drug Induced Liver Injury↗