Search PubMed⌕ Search

Biomedical subjects

B Drumm

Publications and source records attributed to B Drumm.

At least 55 records · Page 3Linked to original sources
PubMed1995

Copper-associated liver disease in childhood.

BACKGROUND/AIMS: Indian childhood cirrhosis is associated with high liver copper concentrations and progressive liver disease with a high mortality. Early treatment with penicillamine was found to reduce mortality and reverse liver damage. We aimed to define the clinical features of copper-associated liver disease outwith the Indian subcontinent and encourage the earlier consideration of the syndrome in cryptogenic liver disease. METHODS: Three European children presented between 10 and 29 months of age with abdominal distension, pyrexia and hepatosplenomegaly. Over 1-5 weeks their condition deteriorated rapidly due to liver failure. Two died within 2 months of onset and one received a successful liver transplant. In two cases consideration of the diagnosis occurred only on examination of the liver after orthotopic liver transplant or death. Light microscopy was used, with haematoxylin and eosin, reticulin and orcein stains. Tissue, plasma and water copper levels were measured by flame atomic absorption spectrometry. RESULTS: All had micronodular cirrhosis and severe hepatocellular necrosis with Mallory bodies and copious-orcein positive material. Liver copper concentrations ranged from 1100-1310 micrograms/g dry weight. For two patients domestic water with high copper content had been used for the preparation of feeds. No environmental source of excess copper could be identified in the third case. CONCLUSIONS: We suggest that the above condition, which is called Indian childhood cirrhosis in the Indian subcontinent and Copper Storage Disease elsewhere, would be better named 'Copper-Associated Liver Disease in Childhood', emphasising the need to consider this disorder in unexplained liver disease and to seek possible sources of excessive copper intake.

Child, Preschool↗
PubMed1995

Association of symptoms with Helicobacter pylori infection in children.

The aim of this study was to determine prospectively whether Helicobacter pylori-associated gastritis is associated with specific symptoms by evaluating whether these symptoms are relieved by treatment of the infection. Symptoms resolved after the eradication of H. pylori in only three of eight children with H. pylori-associated gastritis alone, in comparison with all six children with duodenal ulcer disease.

Adolescent↗
PubMed1995

Helicobacter pylori infection and peptic ulcer disease in children.

Peptic ulcer disease is an uncommon disorder in children. The recent upsurge of interest in peptic ulcer disease in children can be attributed to the importance of studies of children in establishing the role of Helicobacter pylori in the pathogenesis of ulcer disease. This review of recent publications focuses on the role of the organism in peptic ulcer disease, the epidemiology of H. pylori, its significance as a cause of symptoms, and recent advances in the treatment of this infection. The increasing evidence that chronic H. pylori gastritis is possibly a significant risk factor for the development of gastric carcinoma is also discussed.

Breath Tests↗
PubMed1995

Unilateral Beau's lines in childhood reflex sympathetic dystrophy.

Reflex sympathetic dystrophy is characterized by severe pain and autonomic dysfunction in a limb, usually after an injury. We describe a patient with childhood reflex sympathetic dystrophy with unilateral Beau's lines on the nails of the affected hand. Unilateral Beau's lines have not been described previously in this condition to our knowledge, and we discuss their possible pathogenesis.

Child↗
PubMed1995

Helicobacter pylori requires an acidic environment to survive in the presence of urea.

The aim of this work was to study the significance of the urease enzyme in promoting Helicobacter pylori survival in various environments. A urease-positive H. pylori isolate, strain N6, and an isogenic urease-negative strain, strain N6(ureB::TnKm), were incubated in phosphate-buffered saline at a pH ranging from 2.2 to 7.2 for 60 min at 37 degrees C in both the presence and the absence of 10 mM urea. The number of CFU per milliliter in each solution, the pH of the bacterial supernatant, and the amounts of ammonia present in the solutions were measured. H. pylori N6 survived well in solutions with pH values ranging from 4.5 to 7.0 in the absence of urea but survived in solutions only with an initial pH below 3.5 in the presence of urea. Neither strain grew after incubation in an alkaline environment. The pH of an acidic solution (i.e., 3.5) rose rapidly to 8.45 in the presence of the wild-type strain and urea. The urease-negative mutant survived in solutions with pH values ranging from 4.5 to 7.2 irrespective of the presence of urea. Ammonia was present in significant amounts when H. pylori N6 was incubated in the presence of urea. Strain N6 survived exposure to concentrations of ammonia as high as 80 mM. The acid environment of the stomach may be crucial for H. pylori survival in the presence of urea. H. pylori does not survive in the normal environment in the presence of urea because of the subsequent rise in pH rather than ammonia toxicity.

Acids↗
PubMed1995

Preparing the bowel for colonoscopy.

Bowel preparation methods for total colonoscopy in children generally involve whole gut irrigation with electrolyte lavage solutions, which in most children will require hospitalisation for nasogastric tube administration. The aim of the study was to determine the efficacy of oral bisacodyl combined with a single phosphate enema as a bowel preparation regimen in children. In an open prospective trial, 30 children (aged 18 months-15 years) were given oral bisacodyl on each morning of the two days before colonoscopy. The children were maintained on a normal diet. A phosphate enema was administered on the morning of the procedure. The adequacy of bowel preparation was graded as grade I if no faecal material was encountered, grade II if small amounts of faecal material were present in scattered locations, and grade III if there was poor preparation with faecal material precluding satisfactory visualisation of the bowel mucosa. Eight children (26.6%) had minor abdominal cramps when taking bisacodyl, but all had a previous history of similar pain. Five children (16.6%), all under 5 years of age, cried during the administration of phosphate enema. Bowel preparation was considered excellent (grade I) in 26 (86.6%) and good (grade II) in four (13.3%). In all patients adequate visualisation of the bowel mucosa was obtained. Oral bisacodyl combined with a single phosphate enema provides an ideal method of preparing the bowel for total colonoscopy. This preparation allows colonoscopy to be carried out as a day case procedure in children while maintaining them on a normal diet.

Adolescent↗
PubMed1994

Helicobacter pylori infection in children. Is there specific symptomatology?

Helicobacter pylori is an established cause of chronic-active gastritis in both adults and children. However, it is unclear whether H. pylori causes specific clinical symptoms. Therefore, the spectrum of clinical symptoms associated with H. pylori infection was studied in consecutive symptomatic children undergoing diagnostic endoscopy at two pediatric centers, using a structured questionnaire. In Toronto, Canada, 86 of 97 eligible children were enrolled into the study and in Limerick, Ireland, 24 of 29 were enrolled. The frequency of biopsy-confirmed H. pylori infection in Limerick, 16 of 24 (67%), was fivefold higher than in Toronto, 11 of 86 (13%, P = 0.0001). The two study populations were comparable in clinical presentation and duration of symptomatology and did not differ in age (11.9 +/- 3.5 and 11.6 +/- 2.0 years, respectively). Within both study populations H. pylori infection was not associated with specific clinical symptomatology, including duration of abdominal pain, location of pain, and history of melena or vomiting. H. pylori was positively associated with hematemesis in the Limerick group. These findings demonstrate that H. pylori infection in children is not associated with specific clinical symptomatology across varying geographical locations.

Adolescent↗
PubMed1994

Association of gastric metaplasia and duodenitis with Helicobacter pylori infection in children.

Helicobacter pylori infection causes chronic-active gastritis and is associated with peptic ulceration. However, the link between gastric H pylori colonization and duodenal ulcers is not well understood. Therefore, a retrospective, case-controlled study was conducted to determine whether H pylori infection is associated with gastric metaplasia and mucosal inflammation in the duodenum. Biopsy specimens from the duodenal bulb were obtained from 31 of 47 children with H pylori-induced gastritis. Two control groups, matched for age and sex, consisted of 33 children with normal antral histologic evaluation and 33 with H pylori-negative gastritis. Coded duodenal sections were stained with periodic acid-Schiff, hematoxylin-eosin, and silver to examine for gastric metaplasia, mucosal inflammation, and Helicobacter-like organisms, respectively. Thirteen of 31 (42%) H pylori-infected children had gastric metaplasia, in contrast to 1 of 33 with normal histologic characteristics (P < .0001) and 2 of 33 with H pylori-negative gastritis (P < .001). H pylori was detected overlying ectopic gastric mucosa in only 2 of 13 cases. Duodenal ulcers were identified endoscopically in 10 of 13 children with gastric metaplasia and 9 of 18 H pylori-infected subjects without metaplasia (P = NS). Twenty-four of 31 (77%) children with H pylori gastritis had duodenitis compared with 4 of 33 (12%) with H pylori-negative gastritis (P < .001) and 2 of 33 (6%) with a normal antrum (P < .001). Duodenitis was present in 14 of 19 children with H pylori infection and duodenal ulcers and 10 of 12 infected patients without mucosal ulceration (P not significant). These findings demonstrate a higher frequency of both gastric metaplasia and mucosal inflammation in the proximal small intestine of H pylori-infected children. However, there was a lack of correlation between the presence of duodenal ulceration and both gastric metaplasia and duodenitis.

Adolescent↗
PubMed1993

Adherence of Helicobacter pylori to primary human gastrointestinal cells.

Helicobacter pylori adheres only to gastric cells in vivo. However, the organism adheres to a wide variety of nongastric cells in vitro. In this study, we have used flow cytometry to assess the adherence of H. pylori to primary epithelial cells isolated from gastric, duodenal, and colonic biopsy specimens by collagenase digestion. After incubation of bacteria and cells together and subsequent staining with a two-stage fluorescein isothiocyanate-labelled H. pylori antibody method, cells with adherent bacteria could be easily distinguished from cells without bacteria. Binding to Kato III cells (a gastric adenocarcinoma cell line) was saturable when bacteria and cells were mixed at a ratio of 250:1. Adherence to cells isolated from gastric biopsy specimens was significantly better than adherence to cells isolated from duodenal or colonic biopsy specimens. Almost 70% of gastric cells had bacteria bound, in contrast to 30% of duodenal cells and 32% of colonic cells (P < 0.0001). There was no correlation between expression of hemagglutinins by the bacteria and ability to bind to either Kato III cells or primary epithelial cells isolated from gastric biopsy specimens. In view of the strict tropism that the organism exhibits in vivo for gastric cells, the results of this study indicate that primary cells are ideal for assessing the factors that might play a role in the pathogenesis of disease caused by the organism.

Bacterial Adhesion↗
PubMed1993

Helicobacter pylori in the pediatric patient.

H. pylori is the major cause of gastritis in children and adults. Studies in children have demonstrated a specific association between H. pylori and primary gastritis. H. pylori colonization of the gastric mucosa is also important in relation to the natural history of duodenal ulcer disease. Duodenal ulcers do not appear to relapse if H. pylori is cleared from the gastric mucosa. Because of the low incidence of duodenal ulcer disease in children, a multicenter study is required to demonstrate whether this finding is true in children. To date, no specific symptoms have been associated with the presence of H. pylori gastritis in children. H. pylori gastritis may therefore be an asymptomatic condition in the majority of infected children. Further studies in relation to H. pylori gastritis and symptoms in children will be important because it should be easier to identify specific symptoms in children than in adults. H. pylori gastritis in children can be diagnosed by obtaining antral biopsy specimens for culture and histologic study during upper gastrointestinal endoscopy. Serologic study is also a sensitive and specific indicator of H. pylori infection, provided that children's sera are used to standardize the assay. Noninvasive tests such as 13C urea breath tests are very attractive for use in children but are expensive. H. pylori can be cleared from the gastric mucosa in as many as 70% of children by using a combination of metronidazole or amoxicillin with colloidal bismuth subcitrate or bismuth subsalicylate. Studies in children are important in determining the epidemiology of H. pylori. Children in Western societies are not usually colonized. Infection becomes more common with increasing age. Children in underdeveloped countries and those living in poor social conditions in Western countries are much more likely to be infected at a young age. The reason for the increased prevalence of infection among these groups is not known. There is also significant intrafamilial clustering of H. pylori infection. Again, it is unclear why the organism is clustered within households and institutions. Future studies on children will be of importance in determining whether H. pylori gastritis is a cause of specific symptoms, the epidemiology of H. pylori infection, and the possible role of the organism in the natural history of gastric cancer.

Child↗
PubMed1993

Pancreatitis after alar-transverse fusion for spondylolisthesis. A case report.

Acute pancreatitis complicated the postoperative care of a 16-year-old girl treated by alar-transverse fusion for spondylolisthesis. Pancreatitis was diagnosed by a marked increase in plasma amylase in conjunction with abdominal ultrasonography. Symptoms resolved with conservative treatment. Pancreatitis should be suspected when unusual abdominal symptoms persist after spinal surgery.

Acute Disease↗
PubMed1992

Omeprazole therapy for Helicobacter pylori infection.

To determine whether omeprazole eradicates Helicobacter pylori infection of the gastric antrum, six adolescents and one adult with H. pylori colonization of the antrum were entered into a clinical, open trial of medical therapy. Histologic evidence of antral gastritis and three complementary methods to document H. pylori colonization of the stomach (silver stain, urease testing, and culture of antrum) were obtained before and after an 8-week course of omeprazole. In vitro susceptibility to omeprazole and restriction endonuclease analysis were performed on H. pylori isolates obtained from patients before and after omeprazole therapy. Each of the seven patients treated with omeprazole had continued active inflammation in the antrum and one or more features indicative of persisting H. pylori colonization. Minimum inhibitory concentrations and DNA fingerprints of H. pylori isolated after therapy were identical to those of the pre-treatment bacterial isolates in each of the four subjects examined. We conclude that omeprazole therapy alone did not eradicate H. pylori infection of the human antrum. Continued bacterial colonization was not related to either acquired bacterial resistance to the drug or reinfection of the stomach with a different H. pylori strain.

Adolescent↗
PubMed1991

Adherence of Helicobacter pylori to human gastric epithelial cells in vitro.

Gram-negative spiral organisms, currently referred to as Helicobacter pylori, are associated with primary gastritis and duodenal ulceration. The organisms colonise gastric mucus and adhere to epithelial cells of inflamed antra. To further examine the binding of H. pylori to human gastric epithelial cells, we developed and characterised an in-vitro bacterial adherence assay. Scanning electronmicroscopy suggested that spiral-shaped bacteria were adherent to the surface of KATO-III cells which were derived from a human gastric adenocarcinoma. Transmission electronmicroscopy confirmed the attachment of H. pylori to these epithelial cells in tissue culture. Some bacteria were adherent to intact microvilli, others were closely adherent to the plasma membrane in regions where microvilli were effaced. In studies with radiolabelled H. pylori, adherence to epithelial cells in tissue culture contrasted with minimal binding of bacteria to polystyrene wells alone. Incubation of bacteria with gastric cells at 4 degrees C significantly reduced adherence of H. pylori. We conclude that adherence of H. pylori to gastric epithelial cells in tissue culture involved "attachment and effacement mechanisms". This assay could serve as a suitable in-vitro model for the study of the bacterial adhesins and host receptors which mediate attachment of H. pylori to gastric epithelial cell surfaces.

Amino Acids↗