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Biomedical subjects

R Proujansky

Publications and source records attributed to R Proujansky.

27 records · Page 2Linked to original sources
PubMed1991

Patient and procedure variables associated with complications following variceal sclerotherapy in children.

Variceal sclerotherapy has been performed in the pediatric population, but techniques and dosages of sclerosant recommended in the literature are largely empirical. Having accumulated much data through experience with sclerotherapy in children, we have identified patient and procedure variables associated with early and late complications. We reviewed our experience with 37 pediatric patients, ages 1-18, who underwent 150 sclerotherapy sessions. Sclerotherapy was associated with 12 early complications in 11 patients. Early complications were bleeding (five), respiratory problems (three), false channel formation (two), and gross hematuria (two). Four patients developed strictures. We identified the following variables associated with complications: for bleeding, platelet count less than 100,000/mm3; for respiratory complications and false channel formation, weight less than 12 kg; for false channel formation, dosage of sclerosant/kg/session greater than 1.75 ml/kg; for gross hematuria, total sclerosant/session greater than 20 ml. A need for more than six sclerotherapy sessions for obliteration of varices was associated with a greater frequency of stricture formation. Sclerotherapy can be performed safely in children. Patients less than 12 kg or with platelet counts less than 100,000/mm3 should be monitored carefully for respiratory complications and postprocedure bleeding. Sclerosant dosages greater than 1.75 ml/kg, or 20 ml total sclerosant, should be given with caution.

Adolescent↗
PubMed1991

Soluble interleukin-2 receptor as a marker of lymphocyte activation in childhood Crohn's disease.

Serum concentrations of the soluble form of the interleukin-2 receptor (sIL-2R) were determined by an enzyme-linked immunosorbent assay in a group of 39 pediatric and adolescent patients with Crohn's disease and in age-matched ulcerative colitis patients and controls. sIL-2R levels were found to be elevated in patients with Crohn's disease (p less than 0.001), and increased sIL-2R levels were detected in patients with clinically more severe disease. sIL-2R levels correlated more closely with other laboratory markers of disease activity than with a disease activity score. A progressive increase in sIL-2R levels was noted to correlate with endoscopic measurement of disease extent, while sIL-2R levels did not correlate with other markers of systemic lymphocyte activation, suggesting possible local mucosal production. Sequential determinations in individual patients revealed a good correlation between sIL-2R and clinical course. More important, elevated levels of sIL-2R preceded clinical relapse of asymptomatic patients. We conclude that sIL-2R measurement may be a useful adjunct to clinical assessment and routine laboratory testing in pediatric and adolescent patients with Crohn's disease and that serial levels may be predictive of clinical course and the response to therapy.

Adolescent↗
PubMed1989

Gross hematuria following sclerotherapy of esophageal varices in patients with cystic fibrosis.

We report two patients with portal hypertension secondary to cystic fibrosis who developed transient gross hematuria following injection sclerotherapy of esophageal varices. Both patients developed this complication within 6 h of sclerosing sessions during which sodium morrhuate was used. Each cleared her hematuria within 4 days without developing oliguric renal insufficiency. Subsequent sclerotherapy was associated with no untoward effects. These are the only two pediatric patients among 40 whose varices we have sclerosed who have developed gross hematuria at the time of sclerotherapy, and they are our only two patients undergoing sclerotherapy who have had cystic fibrosis. The factors rendering them vulnerable to renal or urinary tract insult in the absence of other systemic complications are unclear. However, the therapeutic endoscopist should be cognizant of this potential adverse reaction when performing sclerotherapy.

Adolescent↗
PubMed1988

The Santmyer swallow: a new and useful infant reflex.

A puff of air administered to the face of 102 subjects (from 33 week's gestation on the first day of life to age 42 years) elicited a reflex swallow identical to a normal primary peristaltic sequence in 88. Subjects who responded were younger than 24 months of age or severely disabled neurologically; those who did not respond were older than 11 months and free of neurological abnormality. Response was variable between 11 and 24 months. This swallow response appears to be a clinically useful but previously unrecognised infant reflex.

Adult↗
PubMed1988

Gastrointestinal syndromes associated with food sensitivity.

A wide range of clinical syndromes exist that are related to adverse reactions to dietary proteins and that affect predominantly the gastrointestinal tract of infants and children. Experimental data suggest a critical role for developmental alterations affecting intestinal permeability and the mucosal immune response that predispose to these conditions. The diagnostic and therapeutic approach to these disorders varies depending on the nature of the presumed offending antigen, the anatomic site affected, the severity of the inflammatory process, and the implications for future dietary and medical management. Ultimately, the proof that a particular dietary antigen is responsible is dependent on observing the response to oral challenge.

Child↗
PubMed1986

Allergic proctitis and gastroenteritis in children. Clinical and mucosal biopsy features in 53 cases.

We have reviewed 53 cases of allergic disorders of the gastrointestinal tract in children, including 15 with principal effects in the rectum (allergic proctitis) and 38 with dominant involvement of the upper and mid portions of the gut (allergic gastroenteritis). Most cases of allergic proctitis had their onset at less than 6 months of age, and all were under 2 years old when they presented with rectal bleeding alone or in combination with diarrhea. Rectal mucosal biopsy revealed in most cases a diffuse increase of eosinophils in the lamina propria together with a focal infiltration of the epithelium by eosinophils. Cases of allergic gastroenteritis affected all age groups and had a lower frequency of overt rectal bleeding. More common were other symptoms (vomiting, pain, and weight loss), an allergic history, anemia, blood eosinophilia, and increased serum IgE. Mucosal biopsy abnormalities were present in the gastric antrum in all cases sampled, the small intestine in 79%, the esophagus in 60%, and the gastric corpus in 52%. The lesions were usually diffuse and marked in the antrum and esophagus; in contrast, they tended to be focal and mild in the small intestine and gastric corpus. All cases of proctitis responded to a dietary change by cessation of symptoms without recurrences, whereas most of those with gastroenteritis had multiple relapses and required corticosteroid therapy.

Biopsy↗
PubMedDate not supplied

Stridor and gastroesophageal reflux: diagnostic use of intraluminal esophageal acid perfusion (Bernstein test).

Five pediatric patients with stridor were evaluated to determine whether gastroesophageal reflux (GER) contributed to their stridor. Intraluminal esophageal acid perfusion (Bernstein test), pH probe, radiographic studies, laryngobronchoscopy, and esophageal histology were utilized. Thereafter, three of the five patients responded to therapy for GER; two did not. The Bernstein test proved to have greater diagnostic reliability than any other test employed, using response to antireflux therapy as the "gold standard" for diagnosing reflux-provoked stridor.

Child↗
PubMedDate not supplied

Idiopathic hypereosinophilic syndrome terminating in acute lymphoblastic leukemia.

Idiopathic hypereosinophilic syndrome (IHES) is a heterogeneous group of disorders characterized by multisystem dysfunction and persistent, extreme eosinophilia of unknown cause. We describe a 9-1/2-year-old boy whose course included several unusual clinical features and terminated 2 years after diagnosis in acute lymphoblastic leukemia (ALL). Serial studies suggest that leukemia was not present earlier in his course. We speculate that this child may have had an evolving lymphoproliferative syndrome with a terminal blast crisis to which the eosinophilia was a nonmalignant leukemoid reaction.

Antigens, Differentiation↗