PubMed Health⌕ Search

Biomedical subjects

S R Orenstein

Publications and source records attributed to S R Orenstein.

At least 55 records · Page 3Linked to original sources
PubMed1993

Scintigraphy versus pH probe for quantification of pediatric gastroesophageal reflux: a study using concurrent multiplexed data and acid feedings.

We performed 12 simultaneous scintigraphic and pH probe studies in children being evaluated for reflux to determine the ability of scintigraphic images in comparison to pH probe data to quantify gastroesophageal reflux in children and to identify an optimal scintigraphic framing interval. We used a multiplexor to synchronize exactly the scintigraphy and pH probe and an acid meal to avoid missing postprandial episodes with the pH probe. We reformatted the studies in both 60-sec and 10-sec images to compare the two framing intervals. The 60-sec images produced better agreement between pH probe and scintigraphy than the 10-sec images for both the number of reflux episodes and the duration of reflux. Of the 64 reflux episodes detected by either method at this coarser framing interval, scintigraphy detected 80%, the pH probe detected 63% and both methods concurrently detected 42%. Of the 681 60-sec images aggregated across patients, scintigraphy detected 55% of those with intraesophageal refluxate, the pH probe detected 96% and both tests concurrently detected 51%. Within patients, the number of positive scintigraphic images in the postprandial hour correlated with the number of images with pH < 4 during the same hour (p = 0.008, and p < 0.0001 if two patients with very rapid gastric emptying are excluded), but not with the results of the 24-hr pH probe study. A 1-hr scintigraphic study formatted in 60-sec frames provides a quantitative representation of postprandial gastroesophageal reflux for children, particularly if they do not have rapid gastric emptying.

Child↗
PubMed1992

Novel primitive swallowing reflex: facial receptor distribution and stimulus characteristics.

We recently described a primitive swallowing reflex: swallowing as a response to a puff of air administered to the face. To identify the facial afferent distribution of this response, the necessary characteristics of the stimulus, and the role of the infant's antecedent behavior, we studied 13 infants who had demonstrated this reflex. We evaluated nine infants by clinically observing for swallowing in response to a total of 135 stimulus applications. All nine had consistently positive responses to the maxillary-ophthalmic area and to the maxillary-mandibular area. Two had consistent responses to stimulation of the mandibular area alone; these were positive. Six had consistent responses to stimulation of the ophthalmic area alone; these were negative. Four infants, evaluated by manometric documentation of swallowing (a total of 137 stimulus applications) demonstrated 47 of 79 (59%) positive responses to stimuli applied to facial areas including any parts of the lips, but only 7 of 28 (25%) positive responses to stimuli applied to facial areas excluding all parts of the lips (chi-square P = 0.002). Light touch to any facial area, including the cornea, failed to produce a swallow in any infant. Crying and sleep were incompatible with the reflex. This newly identified primitive swallow reflex seems to require diffuse stimulation, possibly thermal, to the perioral area of the face in an awake and noncrying infant.

Deglutition↗
PubMed1992

Pancreatitis in young children with cystic fibrosis.

Five young children with cystic fibrosis and abdominal pain were found to have pancreatitis. Diagnosis was delayed in four patients because of the belief that pancreatitis occurs only in older patients with cystic fibrosis. In one patient pancreatitis was diagnosed before cystic fibrosis and diagnosis of cystic fibrosis was delayed. Pancreatitis should be considered as a possible cause of abdominal pain in pancreatic-sufficient children with cystic fibrosis and cystic fibrosis should be considered as a possible cause of pancreatitis, even in the young child.

Abdominal Pain↗
PubMed1992

Thickened feedings as a cause of increased coughing when used as therapy for gastroesophageal reflux in infants.

To determine whether thickening of infant formula feedings with rice cereal increases coughing, we studied 25 infants from birth to 6 months of age, referred for evaluation of gastroesophageal reflux. Coughing was blindly quantified after each of a pair of isocaloric meals (one thickened and one unthickened). Coughing was more frequent after thickened feedings than after unthickened feedings.

Cough↗
PubMed1992

Tardive dyskinesia associated with use of metoclopramide in a child.

Tardive dyskinesia is a chronic, often permanent, movement disorder that has been reported in elderly patients receiving metoclopramide. We describe an 8-year-old boy with tardive dyskinesia that developed when he received metoclopramide as part of therapy for gastroesophageal reflux and erosive esophagitis.

Child, Preschool↗
PubMed1992

Crying does not exacerbate gastroesophageal reflux in infants.

The behavior and intraluminal esophageal pH of 48 infants (5-26 weeks old) were continuously recorded during the 120-min period following their ingestion of a standard volume of apple juice (pH approximately 4). To evaluate the effect of three basic behavior states on the frequency of infant gastroesophageal reflux, the data from all 19 of these infants who spent time in all three behavior states during the 120-min study were analyzed for this study. Results were expressed as the frequency of gastroesophageal reflux episodes per hour of time spent crying, per hour of time awake without crying, and per hour of time asleep. Reflux frequency while crying was compared to reflux frequency while awake without crying; reflux frequency awake (both crying and not crying combined) was compared to reflux frequency asleep. The results indicate that, as has been shown previously, sleeping decreases reflux frequency [nine (1-48) episodes per hour awake vs. two (0-134) episodes per hour asleep, expressed as median (range), p = 0.025], but that, contrary to expectation, crying appears to decrease rather than increase both reflux frequency [11 (0-84) episodes per hour crying vs. 17 (0-213) episodes per hour awake without crying, p = 0.035] and total duration [21% (0-79) of crying time with pH less than 4 vs. 41% (0-93) of noncrying awake time with pH less than 4, p = 0.025]. Crying does not exacerbate reflux in infants with gastroesophageal reflux disease.

Crying↗
PubMed1992

Hoarseness in a child with gastroesophageal reflux.

Hoarseness is not generally appreciated to be a manifestation of pediatric gastroesophageal reflux. We describe a case in which treatment of well-documented gastroesophageal reflux and esophagitis in a young girl with hoarseness and nocturnal cough led to resolution of these symptoms. Possible pathogenetic mechanisms and the difficulty in associating hoarseness with reflux by standard reflux testing are discussed.

Child↗
PubMed1992

Cricopharyngeal dysfunction associated with Chiari malformations.

UNLABELLED: Dysphagia due to upper esophageal sphincter (UES) dysfunction can be a manifestation of Chiari malformation. We evaluated five young children with dysphagia and a Chiari malformation before and after craniocervical decompression. Preoperatively, esophageal manometry with a multilumen perfused catheter revealed failure of complete relaxation of the UES in three patients, pharyngo-UES incoordination in one patient, and both abnormalities in the last patient. Preoperative barium esophagograms were obtained in four of the patients and were normal in two. One patient had nasal regurgitation of barium and delayed passage of barium through the UES. One patient had a posterior pharyngeal impression (bar) at the level of the UES and delayed transit of barium. All patients had clinical and manometric resolution of UES dysfunction following surgical decompression of the Chiari malformation. All swallows were coordinated, and UES relaxations were complete. However, the posterior pharyngeal bar persisted on postoperative esophagogram in the only patient who had had the abnormality preoperatively, although it no longer interfered with passage of barium. Another patient had a narrowed UES with decreased relaxation. Swallowing was radiographically normal in three patients postoperatively. CONCLUSION: Surgical decompression of Chiari malformation may lead to complete clinical and manometric resolution of dysphagia due to upper esophageal sphincter dysfunction. Esophageal manometry is more likely than barium swallow to demonstrate the abnormality, and correlates better with symptomatic improvement postoperatively.

Arnold-Chiari Malformation↗
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

Determining esophageal length from crown-rump length.

Since esophageal length varies linearly with height, intraluminal pH monitoring can be performed at a position within the esophagus that is determined by an equation. Alternatively, pH probes can be positioned under fluoroscopic guidance, though no radiographic landmarks indicate the position that is 87% of esophageal length (where the monitoring is usually accomplished). Our aims were to determine whether a relationship might exist between crown-rump length and esophageal length, for use in patients in whom height is difficult or inappropriate to measure, and to determine whether the mid-right atrium can be used as a radiographic landmark in fluoroscopic pH probe placement. Height, crown-rump length, and distance from the suprasternal notch to the left anterior superior iliac spine were measured in 65 consecutive children undergoing 24-h pH monitoring. As the pH probe was inserted under fluoroscopy, distances from the nose to diaphragm and mid-right atrium were determined. Equations were derived by simple linear regression to describe the relationships between each of the body measurements and esophageal length. There is excellent correlation between crown-rump length and the distances from the nose to diaphragm and to mid-right atrium. The mid-right atrium corresponds to 87% of the nose to diaphragm distance in many patients.

Body Height↗
PubMed1991

Pediatric endoscopic retrograde cholangiopancreatography.

Endoscopic retrograde cholangiopancreatography (ERCP) was performed 42 times in 38 patients aged 14 months to 20 yr at Children's Hospital of Pittsburgh from 1982 to 1990. The adult side-viewing duodenoscope, Olympus JF1T, was used for all procedures. Intravenous sedation was used in 68% of the patients, whereas general anesthesia was employed in the remainder. Visualization of the appropriate ductal system was accomplished in 35 patients (92%). No therapeutic maneuvers were performed at endoscopy. Eleven of the 22 patients with ductal abnormalities underwent surgical treatment, based on the ERCP findings. The only complication encountered was mild pancreatitis in three patients (8%), all with a history of pancreatitis. We conclude that ERCP is a safe, useful procedure in the evaluation of children with pancreaticobiliary disorders, and in the identification of surgically correctable lesions in 29% of those patients.

Adolescent↗
PubMed1990

Prone positioning in infant gastroesophageal reflux: is elevation of the head worth the trouble?

To determine whether head-elevated prone positioning is better than flat prone positioning for infants with gastroesophageal reflux, we studied 100 babies less than 6 months of age who were being examined for reflux with an intraluminal esophageal pH probe while the babies were in each of the two positions, with the use of a crossover design protocol. During both a 2-hour postprandial period and a fasting period, pH probe measurements in each position included (1) minutes with pH less than 4, (2) number of episodes with pH less than 4, (3) mean duration of such episodes, (4) number of such episodes longer than 5 minutes, and (5) the duration of the longest episode. Significant reductions with head elevation were found for only two of these 10 values: the frequency of reflux episodes postprandially (7.5 +/- 0.7 vs 5.9 +/- 0.5 episodes per 2 hours; p less than 0.05) and the frequency of episodes longer than 5 minutes postprandially (1.4 +/- 0.1 vs 1.2 +/- 0.1 episodes per 2 hours; p less than 0.005). There was no significant reduction in the total duration of postprandial reflux nor in any measure of reflux during the fasting period. The 90 infants in whom an abnormal degree of gastroesophageal reflux was documented had no significant differences between flat prone and head-elevated prone position for any of the 10 pH probe measurements. Head-elevated prone positioning is probably not worth the extra effort required to maintain it.

Esophagus↗
PubMed1990

Effects on behavior state of prone versus seated positioning for infants with gastroesophageal reflux.

To evaluate the effect of positioning on behavior in infants with gastroesophageal reflux, 48 infants younger than 6 months of age (range 1.5 to 28 weeks, median 13.5) with reflux were positioned continuously prone (24 infants) or seated (24 infants) during a 120-minute postprandial period, during which behavior was monitored continuously. The prone position was associated with more sleep time, 83.5 (16 to 113) vs 43 (0 to 117) minutes, P = .01. This increase in sleep time in the prone position could be largely accounted for by a tendency toward a decrease in crying time, 19 (0 to 82) vs 38.5 (0 to 91) minutes, P = .07, which is expressed further by the significantly smaller number of prone than seated infants who cried longer than 30 minutes, P = .02. A parallel reduction in noncrying awake time in the prone vs the seated position was not significant: 15 (0-51) vs 31 (3 to 84) minutes, P = .13.

Behavior↗