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Biomedical subjects

W M Liebman

Publications and source records attributed to W M Liebman.

At least 19 recordsLinked to original sources

Disorders of defecation in children: evaluation and management.

In a series of 123 children with disorders of defecation, constipation was the main problem in 89 and fecal incontinence in 34. All but three of the latter also had constipation. The principal physical findings were abdominal protuberance with palpable stool in the bowel and the presence of a fecal mass in the rectal ampulla. Laboratory and radiologic findings were nonspecific except in two of the three patients found to have congenital megacolon (Hirschsprung's disease). Rectal suction biopsy, performed in 69 patients, was diagnostic in all three with Hirschsprung's disease. Anorectal manometry, done in 11 patients, was of limited value. In general, treatment consists of patience and understanding on the part of physician and family, a regimen of orally administered (noncathartic) laxatives with dose gradually reduced over weeks to months, frequent telephone communication between physician and parents, and occasional office visits. Patients with nonretentive fecal incontinence require an intensive psychologic approach. A patient, empathetic, and available physician is one of the most important ingredients in the treatment regimen.

Adolescent

Azulfidine therapy for ulcerative colitis in infancy.

The reported patient represents an example of extensive colonic disease at an uncommon age of involvement. The significant response to salicylazosulfapyridine therapy with this degree of involvement at this age is uncommon. This case suggests the value of an initial trial of medical therapy with salicylazosulfapyridine before the use of steroids or colectomy is contemplated in infants with ulcerative colitis.

Child

Cholestyramine treatment of chronic diarrhea associated with immune deficiency syndrome.

A 5-year-old boy with known severe combined immunodeficiency disease presented with chronic diarrhea, malabsorption and retarded growth. Candida albicans was found in distal duodenal fluid, and invading the intestinal mucosa. Chronic diarrhea persisted after antimycotic therapy, but responded to treatment with cholestyramine. Repeated courses of cholestyramine resin over a 6-month period were required for complete resolution of the gastrointestinal symptomatology.

Candidiasis

Shwachman-Diamond sydnrome and chronic liver disease.

Clinically inapparent persistent chronic liver disease in a 15-month-old male patient with Shwachman-Diamond syndrome is presented. Cryptic hepatic involvement may be an unrecognized feature of the syndrome and should be evaluated in all cases.

Chronic Disease

Recurrent abdominal pain in children: lactose and sucrose intolerance, a prospective study.

Thirty-eight consecutive children with recurrent abdominal pain underwent lactose tolerance tests; 28 of these were also given sucrose tolerance tests. Abdominal pain and abnormal lactose tolerance tests were noted in 11 of 38, while none of the 28 had an abnormal sucrose tolerance test; however, 1 had abdominal pain. Elimination diet for 4 weeks produced significant or total pain relief in 10 of 11 (lactose free) and 0 of 1 children (sucrose free). Lactose intolerance seems to play a contributory role in recurrent abdominal pain in children, while sucrose intolerance does not.

Abdomen

Effect of topical acid on duodenal pepsinogen secretion in the rat.

The effect of topical acid on duodenal pepsinogen secretion was studied in the anesthetized rat. Perfusion of a 5-cm segment of the proximal duodenum with normal saline or buffered saline (pH 7.2 or 6.0) elicited no detectable pepsinogen response. Perfusion with 10, 25, and 100 mN HCl resulted in a graded increase in pepsinogen output. Acetylcholine bromide, 500 microgram/ml, in buffered saline, pH 7.2, also stimulated pepsinogen secretion. The pepsinogen response to 100 mN HCl and to acetylcholine was completely abolished by atropine. Secretin, 2 units/kg, did not alter pepsinogen output during perfusion with buffered saline or acid, while secretin, 75 units/kg, increased pepsinogen output. These observations suggest that topical acid stimulates duodenal pepsinogen secretion through a cholinergic reflex and that secretin is not a significant stimulant of duodenal pepsinogen secretion in the rat within the dose range employed (1--2 units/kg).

Acetylcholine

Serum IgE levels and recurrent abdominal pain in children.

Serum IgE levels were measured in 25 consecutive children with recurrent abdominal pain (RAP) of undetermined cause and 25 consecutive controls of similar age and sex without evidence of RAP, allergy, or parasitic infection. No significant difference in serum IgE levels was demonstreated in children with and without RAP.

Abdomen

Fetal pepsinogens in human amniotic fluid.

The presence of group I (Pg I) and group II (Pg II) pepsinogens was determined in 59 samples of human amniotic fluid between 11 and 40 weeks of gestation. Pg I was present in all of the samples, while Pg II was present only in samples of gestational age 32 weeks or older. No differential pattern of the fractions was present, although the first fraction of Pg I was not present in any of the samples. The sequential appearance of Pg I and Pg II suggests their fetal origin and that the synthesis of Pg I by fetal gastric mucosa may precede that of Pg II, thus serving as a potential marker of fetal maturity.

Amniotic Fluid

Recurrent abdominal pain in children: a retrospective survey of 119 patients.

The clinical pattern of 119 children with recurrent abdominal pain, located most commonly in the periumbilical region, revealed no distinct features. The most common associated symptoms were pallor, tiredness and anorexia. The most important socioenvironmental and behavioral factors were marital turmoil in 44%, school activity in 32%, and perfectionism in 30%. Laboratory and radiologic and fiberoptic endoscopic studies were uniformly unremarkable. Counseling on a continuing basis helped 105 of these children.

Abdomen

Immunochemical characterization and cellular localization of pepsinogens in cat and dog.

The antigenic relationships and cellular localization of cat and dog pepsinogens were investigated by electrophoretic analysis, immunodiffusion, immunoelectrophoresis, immunoabsorption, and by immunofluorescence, respectively. Rabbit antiserum to human and hog group I (Pg I) and group II pepsinogens (Pg II) had been previously prepared. Electrophoretic analysis revealed at least eight distinct proteases in extracts of gastric and proximal duodenal mucosa, resistant to alkalinization but destroyed by sequential accidification and neutralization. Rabbit antiserum to Pg I (anti-Pg I) and Pg II (anti-Pg II) produced a single precipitin arc against each extract forming a line of nonidentity. Immunoelectrophoresis of extracts produced a single precipitin arc against anti-Pg I or anti-Pg II. The specificity of the antibodies for the group I or group II pepsinogens was confirmed by immunoabsorption. By immunofluorescnece, both Pg I and Pg II were present in mucous neck and chief cells in fundic mucosa, in the pyloric gland cells in antral mucosa, and Brunner's glands in the proximal duodenum. The results indicate that canine and feline pepsinogens are electrophoretically heterogenous, that canine and feline Pg I share antigenic determinants with each other but not with Pg II, that a similar positive relationship exists for Pg II, and that both Pg I and Pg II are localized to the peptic cell mass, consisting of four types of cells.

Animals