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Biomedical subjects

R Wyllie

Publications and source records attributed to R Wyllie.

At least 73 records · Page 4Linked to original sources
PubMed1991

The spectrum of eosinophilic gastroenteritis. Report of six pediatric cases and review of the literature.

Eosinophilic gastroenteritis is an inflammatory disease of unknown etiology characterized by infiltration of the gastrointestinal tract with eosinophilic leukocytes, accompanied by varying abdominal symptoms and usually by peripheral blood eosinophilia. We report our experience with six pediatric cases presenting to the Cleveland Clinic Foundation over the past eight years. Unusual findings in our patients included ascitic fluid without eosinophilia and eosinophilic pericarditis (one patient), and eosinophilic cholecystitis (one patient). Endoscopic examination and biopsy helped to establish the diagnosis in all patients. Bone marrow aspiration supported the diagnosis by demonstrating eosinophilia and identifying reactivation of the disease, even in cases without peripheral eosinophilia. All six patients responded promptly to prednisone. Diagnosis is challenging and eosinophilic gastroenteritis may be more common than is recognized. This series of cases significantly expands the spectrum of the disease in children, and documents the usefulness of diagnostic endoscopy in this condition.

Adolescent↗
PubMed1991

Routine laboratory monitoring for serious adverse effects of antiepileptic medications: the controversy.

Rare, serious adverse effects of antiepileptic drugs (AEDs) include hepatotoxicity and bone marrow suppression. Current management includes routine laboratory monitoring during therapy with AEDs, a practice, however, that is controversial, as some clinicians believe that such monitoring is ineffective and that clinical monitoring is sufficient. Unfortunately, routine laboratory monitoring cannot predict acute idiosyncratic drug reactions, which will remain unpreventable until specific markers are available to identify susceptible patients. Nevertheless, routine laboratory monitoring may be helpful for early detection of chronic adverse reactions such as subclinical hepatotoxicity, leukopenia, or thrombocytopenia, which are usually mild and clinically insignificant but are occasionally more severe. Routine liver function tests may be especially important during valproate therapy because pathologic data suggest that some cases of valproate (VPA)-induced hepatic failure are the result of chronic liver damage and cirrhosis. Although levels of hepatic enzymes may be elevated during an early reversible stage of VPA toxicity, by the time clinical symptoms develop, hepatic failure may be irreversible.

Anemia, Aplastic↗
PubMed1990

Management of children and adolescents with inflammatory bowel disease.

The management of children and adolescents with inflammatory bowel disease requires all the skills offered by the health care team. This article reviews the principles of therapy, the specifics of therapy, and the attitudes of the authors relating to long-term management of these patients. Specific recommendations relating to nutritional support for patients are also made. A pertinent updated bibliography is also given.

Adolescent↗
PubMed1987

Dumping syndrome in children.

Dumping syndrome developed in seven children after gastric surgery, (Nissen fundoplication in six, Whipple procedure in one). The patients ranged from age 10 months to 13 years, and four of the seven were neurologically impaired. The diagnosis was made by demonstrating an abnormal response to an orally administered glucose challenge. The pediatric literature records only eight cases, but we believe that dumping syndrome is more common in children than once believed. Dietary management can often dramatically diminish the associated symptoms.

Child↗
PubMed1984

Pancreatitis associated with valproic acid therapy.

Four patients had pancreatitis associated with valproic acid therapy. Three patients received valproic acid at usual doses, and all were free of other symptoms of toxic reactions, with serum levels of valproic acid in the usual therapeutic range. Two patients underwent exploratory laparotomy prior to diagnosis. Complications included pseudocyst, pericardial effusion, laparotomy wound infection, and coagulopathy. All patients recovered with discontinuation of valproic acid therapy and enteral feeding and administration of intravenous fluids. After recovery, a valproic acid regimen was restarted uneventfully (in one patient). All were asymptomatic with normal serum amylase levels after five to 14 months. Pancreatitis is a serious complication of valproic acid therapy that must be considered in any patient receiving valproic acid who experiences severe abdominal pain and vomiting.

Abdomen↗
PubMed1980

Gastroesophageal reflux in infants and children comparative accuracy of diagnostic methods.

To assess the diagnostic accuracy of methods employed for detection of gastroesophageal reflux, 30 infants and children with symptoms of GER were evaluated by upper gastrointestinal series, gastroesophageal scintiscan, measurement of mean resting lower esophageal sphincter pressure, esophageal intraluminal PH measurement (acid reflux test), and endoscopy. Fifteen control patients were also evaluated by the above studies. GER was demonstrated by UGI in 15 and by GE scintiscan in 17 study patients. LESP less than 15 mm Hg was noted in 12 and a positive acid reflux test was obtained in 29 study patients. Esophagitis was detected in two (of 30) study patients radiographically and in 15 (of 21) study patients by upper gastrointestinal endoscopy. Pulmonary aspiration of gastric contents was not detected by the radionuclide method. None of the 15 control patients had GER demonstrated with any of the above methods. These studies indicate that (1) the acid reflux test correlates most closely with symptoms of GER; (2) THE GE scintiscan is complementary to the UGI in the diagnosis of GER, i.e., the combination increases sensitivity; (3) normal LESP does not necessarily exclude GER; and (4) endoscopy is superior to the UGI in detecting the presence of esophagitis.

Adolescent↗