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Biomedical subjects

R Shepherd

Publications and source records attributed to R Shepherd.

116 records · Page 7Linked to original sources
PubMed1977

Protracted diarrhoea in infancy. Analysis of 82 cases with particular reference to diagnosis and management.

Eighty-two cases of protracted diarrhoea in infancy presenting over a 6-year period have been analysed, with particular reference to diagnosis and management. The patients fell into 1 of 2 categories according to whether a specific diagnosis was established or not. A diagnosis (category 1) was established in 59 (72%), the commonest diagnoses being coeliac disease (33-2%), secondary disaccharide intolerance (12-2%), and cows' milk protein intolerance (12-3%). Other diagnoses included primary sucrase-isomaltase deficiency, Shwachman's syndrome, ulcerative colitis, ganglioneuroma, defective opsonization, staphylococcal pneumonia, and Hirschsprung's disease. Despite intensive investigation in diagnosis could not be established in 23 (28%) infants (category 2). Age of onset of symptoms in this group tended to be earlier than in category 1 patients, and 6 (7%) presented with diarrhoea dating from birth. Of particular interest in these 6 patients was the high incidence of associated extraintestinal anomalies, and of sibs who had died after protracted diarrhoea dating from birth. 4 of these 6 infants died, accounting for a mortality of 5% for the whole series. The remaining 17 (21%) patients in category 2 presented at a mean age of 4-9 weeks with a range of 1-18 weeks. All these 17 patients made an excellent response after institution of a chicken-based dietary formula, the details of which are presented. The pathophysiological mechanisms which may be operating in infants with protracted diarrhoea are discussed.

Animals↗
PubMed1976

Clinical comparison between glucose and sucrose additions to a basic electrolyte mixture in the outpatient management of acute gastroenteritis in children.

In a double-blind trial in 94 children attending outpatients the value of glucose or a sucrose addition to a basic electrolyte mixture for the management of acute gastroenteritis was compared. Of the children treated with added sucrose 10% failed to respond compared with 27% of those treated with added glucose. This difference was significant (P=0-05), but the time to recovery in those in the two groups who responded to treatment was not significantly different. Thus, despite theoretical advantages, there was no practical advantage in using glucose rather than sucrose. A 5% sucrose electrolyte solution with its relatively low osmolality, ready availability, and ease of preparation is recommended as the treatment of choice in the outpatient management of acute gastroenteritis in infancy.

Child, Preschool↗
PubMedDate not supplied

Wilson's disease in an Australian aborigine.

Wilson's disease is due to a genetically determined defect inherited as an autosomal recessive trait. Most reported cases have been caucasoid. This report describes a case of Wilson's disease in an Australian Aboriginal girl, only the second such case reported.

Child↗
PubMedDate not supplied

Energy expenditure in infants in health and disease.

Measurement of energy balance represents a basic theoretical concept in the determination of nutritional and fluid requirements in humans in health and disease. Infants have special nutrient requirements, more limited reserves and relative immaturity of organ function. Energy requirements of infants have been based either retrospectively on intakes required to achieve normal growth or on equations derived from energy expenditure studies performed early this century. Recently, improved techniques for studying resting energy expenditure (REE), total energy expenditure (TEE) and metabolically active body compartments in infants have facilitated more accurate estimates of energy requirements. Such studies indicated that current reference values for energy requirements are overestimates, and that compared with measured values, predicted values vary markedly between the various predictive equations with wide co-efficients of variation. In disease states with altered body composition, such as cystic fibrosis and end-stage liver disease, predictive equations markedly underestimate both energy and fluid requirements. In cystic fibrosis, both TEE and REE are 25% higher than values in healthy infants. In extrahepatic biliary atresia, energy expenditure per unit body cell mass is markedly elevated, suggesting that this is a catabolic condition in infants. Current estimates of energy and fluid requirements in both health and disease in infants need reappraisal. Bedside and free living energy expenditure methodology should be used to define accurately components of energy requirement in individual infants.

Biliary Atresia↗
PubMedDate not supplied

Congenital nasolacrimal duct obstruction: natural history and the timing of optimal intervention.

Nasolacrimal duct obstruction (NLDO) is a relatively common clinical problem. Debate continues about optimal management. Intervening early and intervening late each have advantages and disadvantages. We reviewed the world literature on NLDO. We assembled information on occurrence, natural history, and results of treatment. Spontaneous remission data were used to derive the probability of continued obstruction versus age. The prevalence a hypothesized treatment-resistant form of NLDO was estimated. Symptomatic NLDO probably occurs in 5 to 6% of infants. Given a symptomatic case under the age of 14 months, the probability of spontaneous remission within the following month appears to be approximately one of three. Probe failure risk increases with age, doubling every 6 months. Increasing probe failure risk may be due to self-selection. Preliminary analysis of management strategies suggests that lacrimal duct probing at age 4 months in the office is the most cost-effective strategy. Further descriptive studies of NLDO remission and treatment are indicated.

Age Factors↗