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Biomedical subjects

S R Orenstein

Publications and source records attributed to S R Orenstein.

At least 73 records · Page 4Linked to original sources
PubMed1990

Esophagitis in infants. Morphometric histological diagnosis and correlation with measures of gastroesophageal reflux.

To assess the incidence of histological esophagitis in infants less than 2 yr old with symptoms of gastroesophageal reflux, 35 infants were studied with esophageal suction biopsy and pH probe monitoring. Intraepithelial and lamina propria inflammatory cells, basal cell layer thickness, and papillary height were quantitated. Distal esophageal sections from infant sudden death trauma victims were used to provide normal morphometric control values. The upper limit of normal for each of the four histological parameters of esophagitis was defined as the mean plus three standard deviations. The values thus derived were similar to established adult normal values. Seventy-seven percent of the patients had at least one abnormal histological parameter (intraepithelial eosinophils or neutrophils, thickened basal cell layer, or increased papillary height) and were thus considered to have esophagitis. These measures of esophagitis all correlated well with each other, providing an internal consistency to the histological interpretation. Lamina propria eosinophilia correlated highly with intraepithelial eosinophils (r = 0.98) and was found to have a sensitivity of 41% and specificity of 89% for diagnosing histological esophagitis, defined as abnormality of any of the four histological parameters. Ninety-three percent of the patients with histological esophagitis had significant reflux as determined by pH probe monitoring. However, there was generally poor correlation between the severity of the esophagitis as quantitated by morphometric parameters and severity of the reflux as measured by pH monitoring. Esophageal suction biopsies, which provide adequate specimens for morphometric interpretation, are appropriate for diagnosing reflux esophagitis in infants.

Basement Membrane↗
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

Crohn's disease of the vulva in an 8-year-old girl.

An 8-year-old girl had Crohn's disease of the vulva 16 months before the onset of intestinal symptoms. At the time of diagnosis she had no evidence of systemic disease. Cutaneous and intestinal lesions responded rapidly to corticosteroids and metronidazole. Crohn's disease must be considered in the differential diagnosis of nontender, red, edematous plaques of the genital area.

Biopsy↗
PubMed1988

Effect of nonnutritive sucking on infant gastroesophageal reflux.

To evaluate the effect of pacifier use (nonnutritive sucking) on gastroesophageal reflux in infants, 48 infants younger than 6 months of age with pathologic reflux were prospectively evaluated with pH probe. In each infant, parameters of reflux were blindly quantified during paired periods in a cross-over design when pacifier use was either encouraged or prohibited. To determine whether positioning was a factor in the effect of nonnutritive sucking on reflux, 24 of the infants were studied seated and 24 studied prone. Pacifier use significantly affected only the frequency of reflux episodes, increasing it in prone infants from 7.2 +/- 1.1 to 12.8 +/- 2.3 episodes/120 min postprandially (p = 0.040) and decreasing it in seated infants, from 21.1 +/- 3.1 to 14.8 +/- 2.6 postprandially (p = 0.003) and from 17.3 +/- 4.8 to 5.9 +/- 0.9 in the fasting period (p = 0.035). It did not significantly affect the clearance of reflux episodes or the total reflux time. These results suggest that infants with pathologic reflux frequency might best avoid pacifier use while in the beneficial prone position. When seated position is necessary, the pacifying effects of nonnutritive sucking may be useful in decreasing reflux events as well as in reducing crying behavior.

Fasting↗
PubMed1988

Simultaneous acquisition of physiological data and nuclear medicine images.

A technique has been developed that allows the simultaneous acquisition of both image and physiological data into a standard nuclear medicine computer system. The physiological data can be displayed along with the nuclear medicine images allowing temporal correlation between the two. This technique has been used to acquire images of gastroesophageal reflux simultaneously with the intraluminal esophageal pH. The resulting data are displayed either as a standard dynamic sequence with the physiological data appearing in a corner of the image or as condensed dynamic images.

Electronic Data Processing↗
PubMed1987

Thickening of infant feedings for therapy of gastroesophageal reflux.

To assess the effect of thickening of feedings on gastroesophageal reflux and gastric emptying, 20 infants were examined with technetium scintigraphy and detailed behavioral observation after each of a pair of feedings, one with radiolabeled infant formula alone and the other with radiolabeled formula thickened with dry rice cereal. The thickened and unthickened meals were followed by similar amounts of scintigraphically demonstrated gastroesophageal reflux. However, the number of episodes of emesis (1.2 +/- 0.7 vs 3.9 +/- 0.9 per 90 minutes postprandial), the percent of gastric emptying at 30 minutes (17.8% +/- 2.7% vs 22.4% +/- 2.4%), the time spent crying (11.7 +/- 3.1 minutes vs 17.6 +/- 3.8 minutes per 90 minutes), and the total time spent awake (45.2 +/- 5.9 minutes vs 53.1 +/- 4.9 minutes per 90 minutes) were significantly less after the thickened feedings. Because thickening of infant feedings increases the caloric density, decreases emesis, decreases crying time, and increases sleep time in the postprandial period, it is likely to be beneficial in the treatment of infants with gastroesophageal reflux associated with failure to thrive.

Crying↗
PubMed1986

Enteral versus parenteral therapy for intractable diarrhea of infancy: a prospective, randomized trial.

Thirteen infants with intractable diarrhea were classified as having severe or moderate malabsorption on the basis of D-xylose absorption. Within each group (designated severe and moderate), patients were randomly assigned to continuous enteral nutrition (CEN) with an elemental formula or to an alternative therapy: total parenteral nutrition (TPN) for the severe patients or intermittent oral nutrition (ION) with the elemental formula for the moderate patients. Within the severe group, CEN and TPN produced similar correction of malnutrition (6.0 +/- 2.5 weeks vs 6.5 +/- 2.5 weeks for weight to reach the 5th percentile for age, P = 0.69), but CEN was associated with faster resolution of malabsorption and diarrhea (2.8 +/- 0.5 weeks vs 9.8 +/- 1.1 weeks, P = 0.02), fewer complications, and less expensive hospitalization than TPN. The moderate group was too small for clear distinctions between the two therapies. D-xylose absorption effectively distinguished between severe malabsorption (requiring 20.6 +/- 2.6 days of enteral therapy before tolerance of oral feeding) and moderate malabsorption (requiring 11.6 +/- 1.7 days), P less than 0.03. Enteral therapy is more widely applicable in severe intractable diarrhea of infancy than has been appreciated, and can produce superior results to TPN.

Clinical Trials as Topic↗
PubMed1985

Esophageal stricture dilatation in awake children.

Dilatation of esophageal strictures in children has generally been performed in the hospital under general anesthesia, or under deep sedation. We report here a series of 211 dilatations in 13 pediatric patients who had these procedures performed in the outpatient department, 72% of them without any sedation, during a 4-year period. This report characterizes the children, the method of outpatient dilatation, and our results. At the end of the study period, six of the patients no longer required dilatation after five to 14 procedures; four patients still required dilatation at twice-yearly intervals; and three patients remained on an active schedule of dilatations at intervals less than 5 months. Esophageal lumen diameter increased and symptoms improved in all of the children. Catch-up weight gain occurred in one-half of those initially below the 10th percentile. Dilatation without anesthesia or sedation was preferred by all of the parents, and by those children old enough to express a preference. Estimated reduction of medical costs by more than $100,000 was realized, compared with bouginage using general anesthesia. No episode of perforation, significant hemorrhage, documentable aspiration, or neurologic complication occurred. Outpatient dilatation without anesthesia is an effective method of treating esophageal strictures in children.

Adolescent↗
PubMed1984

Manometric guidance in suction biopsy of the esophagus in children.

Esophageal histological observation is the most reliable indicator of esophagitis. Biopsy specimens obtained by endoscopic grasp forceps are sometimes inadequate for histologic evaluation, and established methods for determining the location of suction biopsies have been imprecise or inconvenient. A method was developed employing manometric control to locate the site of suction biopsies performed with the Quinton multipurpose suction biopsy instrument. With the use of this technique, biopsies were performed in 40 children without failure and without complication.

Biopsy↗
PubMed1983

The infant seat as treatment for gastroesophageal reflux.

Positioning in the infant seat ("chalasia chair") for treatment of infants with gastroesophageal reflux is presumed to have a beneficial effect. We undertook a controlled, prospective study of such positioning to evaluate this purported benefit. Nine infants with documented gastroesophageal reflux participated in 18 paired two-hour postprandial trials in an infant seat and in the horizontal prone position. Distal esophageal pH monitoring demonstrated longer exposure to gastroesophageal reflux while infants were in the seat than when they were prone (28.2 +/- 6.4 per cent vs. 12.8 +/- 3.7 per cent of total time with pH less than 4.0, P = 0.023), a difference due largely to more episodes (16.0 +/- 2.4 vs. 10.1 +/- 2.3 per two-hour postprandial period, P = 0.002). We conclude that the infant seat, rather than being therapeutic in gastroesophageal reflux in children under six months of age, is actually detrimental, when compared with simply placing an infant prone.

Clinical Trials as Topic↗
PubMed1983

Positioning for prevention of infant gastroesophageal reflux.

A controlled, prospective comparison of the use of the infant seat versus prone, head-elevated positioning in a harness was undertaken in 15 infants with gastroesophageal reflux. pH monitoring of the distal esophagus demonstrated less reflux in the harness than in the seat (P less than 0.001) during 19 pairs of two-hour postprandial trials. This difference was the result of both fewer episodes (P less than 0.001) and briefer episodes (P less than 0.05). Prone-elevated positioning in the harness described is superior to positioning in an infant seat in the treatment of gastroesophageal reflux in infants younger than 6 months.

Esophagogastric Junction↗